RETINAL MICROCIRCULATION INVESTIGATION IN TYPE I AND II DIABETIC PATIENTS WITHOUT RETINOPATHY USING AN ADAPTIVE OPTICS RETINAL CAMERA.

CONTEXT: State of art imaging techniques might be a useful tool to early detect the retinal vessels lesions in diabetes. OBJECTIVE AND DESIGN: This analytical observational study investigates the retinal microcirculation changes in type I and II diabetic patients without retinopathy using adaptive optics ophthalmoscopy (AOO) and optical coherence ophthalmoscopy angiography (OCTA). SUBJECTS AND METHODS: Fifty-five subjects were included in this study and were divided in three groups: type I diabetic group (n=16), type II diabetic group (n=19) and control group (n=20). An adaptive optics retinal camera was used to assess the parameters of the temporal superior retinal arterioles. Moreover, vessel density of the superficial capillary plexus across the parafoveal area was measured with OCT-A. All cases were investigated once, in a cross-sectional design. RESULTS: Diabetic patients from both groups had a higher wall-to-lumen-ratio compared to the controls (p=0.01 and 0.01, respectively). Interestingly, no significant differences were found between the two diabetic groups (p=0.69). Moreover, the vessel density was smaller in the type I diabetic group than in the control group (p=0.001). CONCLUSION: AOO might be a useful tool to detect early retinal vascular changes in diabetes before any clinical signs and together with OCTA it might bring important information on the prognostic and pathophysiology of the disease.

Ethiopatogenic Hypotheses in Lichen Planus.

Lichen planus is a mucocutaneous inflammatory dermatosis characterized by a papular rash; the disease is self-limited, has several clinical subtypes and follows a chronic or subacute clinical course. This article presents some etiological hypotheses: stress, genetic predisposition, systemic diseases, viral infections, materials used in dentistry. Also, medicines or contact allergens can cause lichenoid reactions, which are the main differential diagnosis. Autoimmune hypothesis can be supported by the association with other autoimmune diseases, such as ulcerative colitis, alopecia areata, vitiligo, dermatomyositis, morphea, lichen sclerosus, myasthenia gravis. This disease seems to be mediated through an antigenic mechanism of cytotoxic T lymphocyte activation, and production of proinflammatory cytokines, cascade of events that causes apoptosis of basal keratinocytes. A good understanding of the pathogenesis, clinical presentation and early diagnosis of lichen planus is critical in determining the appropriate therapeutic management. This present article aims to present and discuss the various etiopathogenetic concepts of lichen planus.

Clinical-epidemiological trends of herpes zoster: a 5-year study.

UNLABELLED: Herpes zoster (shingles) is a neurocutaneous viral disease, in recent years its incidence increasing throughout the world. AIM: To study the incidence of herpes zoster among Iasi county patients requiring hospital admission and to analyze the clinical and epidemiological features and socioeconomic status of the study group. MATERIAL AND METHODS: Retrospective study of 158 patients admitted to the largest clinical dermatology department in North-eastern Romania, the Clinical Dermatology Department of the Iasi "Sf. Spiridon" University Emergency Hospital. The study was conducted over a period of five years and included the analysis of epidemiological data, socioeconomic status, clinical forms of disease, associated diseases, pathology reports for skin biopsy fragments, administered treatment, and disease course. RESULTS: This study confirms that shingles is not a sex-specific disease, the female/male ratio being 1.22: 1. Most patients belonged to the age group 70-80 years, accounting for about 35% of all patients, followed by the age group 60-70 years (24.6% of cases). A slight increase in the number of cases was recorded in autumn and summer in patients living in rural areas. 1.3% of the cases were diagnosed both with the disseminated form of disease, and complications (eczematization, bacterial superinfection, skin necrosis). 7.6% of patients presented additional skin disorders (pityriasis versicolor, impetigo, psoriasis vulgaris, mucocutaneous candidiasis), which raised the suspicion of an immune deficiency predisposing to shingles. The absence or late initiation of specific antiviral therapy correlated with prolonged hospital stay up to 4-6 days. We found an association between the erythematous form of shingles and young age, while the hemorrhagic or necrotic forms were present in the elderly and/or ill patients. The course was favorable and the length of illness was significantly shortened when the treatment adequate to the clinical form was administered. Associated comorbidities (essential hypertension 38.6%, dyslipidemia 24.6%, diabetes, mellitus 9.49%, chronic venous disease, other skin diseases) represent a factor complicating the development of herpes zoster by the cumulative stress the body is exposed to. CONCLUSIONS: The main statistically significant epidemiological data in the study group are: older age (over 60 years), associated diseases (which by the marked imbalances induced in the body increase the risk of varicella zoster virus reactivation) intense psychological stress. The following parameters did not change the risk of developing shingles: area of origin, sex, the season at disease onset, number of hospital days, and administered treatment. Early diagnosis and treatment of this disease is important for maintaining a good quality of life, to avoid complications, to limit the extent of the disease and its transmission to others.

Alopecia--a challenge for dermatologists.

Alopecia is a loss of hair in the areas where it normally grows. It has to be distinguished from atrichia, the congenital absence of hair due to the absence of hair follicles, and hipotrichosis, scarcity or absence of hair in some congenital diseases. Alopecia is either scarring, when the skin appears atrophic, scaling, and smooth and the hair follicles are absent, or nonscarring, when hair loss is not accompanied by the destruction of hair follicles. This paper is a review of all types of alopecia and their features in an attempt to make them easier to identify and differentiate.