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.

Possible progression of subacute lupus erythematosus--case report.

Subacute lupus erythematosus (SLE) is a specific form of lupus erythematosus characterized by prevalently cutaneous manifestations usually with a good prognosis. It is more common in patients aged 15 to 70 years, and there is a female predilection. This form accounts for 10% of all lupus erythematosus cases. We present the case of a 57-year-old male patient diagnosed at age 35 with chronic psoriasiform subacute lupus erythematosus, pathologically confirmed at the Iasi Dermatology Clinic. At the age of 54 years he had multiple ischemic strokes, followed by deterioration of general status, and at 56 years deep vein thrombosis in the right leg. The patient presented the erythematous-squamous lesions specific to psoriasiform SLE localized both on the upper third of the body and knees and associated with submucosal lesions of the lower lip, oral mucosa and appendages. The patient also presented hypo- and hyperpigmentated atrophic scar-like lesions. Laboratory tests performed during the last two admissions showed the presence of anti-ds DNA and antiphospholipid antibodies, inflammatory syndrome, and nitrogen retention syndrome. Treatment consisted of systemic and local dermatocorticoids and associated medication, emollient lotions and creams with SPF 50+, with slowly favorable progression. The peculiarity of the case lies in the chronic progression without significant systemic involvement for 19 years, and then in 2 years the antiphospholipid antibody syndrome and a shift to systemic lupus erythematosus to occur.

Napkin psoriasis--case report.

Psoriasis is a chronic inflammatory disease that can affect up to 1% of children. Genetic (family history of psoriasis) and environmental factors (bacterial or viral infections, stress, and trauma) are frequently involved in its occurrence. Napkin psoriasis is a particular form of psoriasis affecting mainly children younger than 2 years of age and can be classified together with other diseases under diaper rash. We present the case of a 4-month-old infant, born at term, naturally, weight and height within the normal range, who was brought to the Dermatology Clinic for the occurrence of erythematosquamous lesions in the anogenital area, buttocks and upper third of the thighs, with subsequent dissemination of lesions. The onset of symptoms began a few days after a respiratory tract infection. Initially he received treatment with systemic antibiotic and topical corticosteroid and antibiotic with unfavorable outcome. Laboratory tests revealed iron-deficiency anemia, leukocytosis, thrombocytosis, accelerated ESR, marked hepatic cytolysis, hyperphosphatemia and nasal carriage of Staphylococcus aureus. A systemic antihistamine and nonspecific desensitization treatment was administered. Topical treatment consisted in the removal of predisposing factors and irritants (diaper, urine) by rigorous hygiene, application of topical non-fluorinated cortico-steroid and use of emollients, with favorable course of the lesions. The peculiarity of the case is that the diagnosis of psoriasis was based on history, physical examination and laboratory tests, in the absence of a pathology examination to confirm the diagnosis. Pathology examination could not be performed due to patient's age as biopsy required general anesthesia.

Comparison of the efficacy and safety of bilastine 20 mg vs levocetirizine 5 mg for the treatment of chronic idiopathic urticaria: a multi-centre, double-blind, randomized, placebo-controlled study.

BACKGROUND: Bilastine is a novel nonsedative H(1)-receptor antagonist, which may be used for the symptomatic treatment of chronic idiopathic urticaria (CU). The aim of this study was to compare the clinical efficacy and safety of bilastine 20 mg vs levocetirizine 5 mg and placebo in CU patients with moderate-to-severe symptoms. METHODS: Overall 525 male and female subjects aged 18-70 years were randomized to receive bilastine 20 mg, levocetirizine 5 mg or placebo, once daily for 28 days, in double-blind manner, in 46 centres across Europe and Argentina. Patients rated symptoms of pruritus, number of wheals, and maximum size of wheals (on predefined scales) as reflective (over past 12 h) symptoms twice daily, for assessment of change from baseline in the total symptoms scores (TSS) over 28 days as the primary efficacy measure. Changes in reflective and instantaneous symptoms scores, Dermatology Life Quality Index (DLQI), and CU-associated discomfort and sleep disturbance were assessed as secondary outcomes. Safety was assessed according to adverse events, laboratory tests and electrocardiograms. RESULTS: Bilastine reduced patients' mean reflective and instantaneous TSS from baseline to a significantly greater degree than placebo (P < 0.001); from day 2 onwards of treatment. The DLQI, general discomfort, and sleep disruption were also improved significantly in bilastine-treated patients as compared with placebo-treated patients (P < 0.001 for all parameters). Comparison with levocetirizine indicated both treatments to be equally efficacious as well as equally safe and well tolerated as compared with placebo. CONCLUSIONS: Bilastine 20 mg is a novel effective and safe treatment option for the management of CU.

[Tinea of the eyebrows. About six cases]. / Tinea sprâncenelor; observatii asupraa sase cazuri.

INTRODUCTION: Tinea of the eyebrows is a part of tinea capitis. M. canis, T. violaceum, T. verrucosum and T. mentagrophytes are the most frequently implicated fungi in tinea of the eyebrows. PATIENTS AND METHODS: Our study includes six patients who presented erythematous scaly plaques and pustules on the eyebrows. The eyebrows hairs were grayish, friable and broken leaving alopecic areas. Direct microscopy of the infected hairs of the eyebrows lesions followed by culture on Sabouraud dextrose agar were effectuated in every patient at the beginning, during and the end of treatment. RESULTS: The direct microscopy revealed ectothrix-type hair shaft infection forming a sheath of small-spores on the outside of eyebrows hairs and M. canis was identified on cultures of Sabouraud's dextrose in all cases. Systemic treatment was initiated with griseofulvin 1000 mg/day in two patients and with terbinafine 250 mg/day in four patients associated with topical antimycotics for 8 weeks. After 8 weeks of treatment mycological cure was obtained in 100% of cases. CONCLUSION: Tinea of the eyebrows is a rare disease that occurs usually secondary to other dermatophytic infection and rarely isolated.

[Blepharitis--rare in systemic lupus erythematosus]. / Blefarita, o afectare rara in lupusul eritematos cronic.

Chronic lupus erythematosus often appear on the face, ears, and scalp. In exchange eyelids involvement as a chronic blepharitis is rare. We describe six cases of discoid lupus erythematosus with lesions on the face and ears who have eyelids involvement, too. Blepharitis is a rare involvement of the chronic lupus erythematosus and in case that is isolated, the diagnosis is belated and can lead to complications. The involvement of the lower eyelids is more frequently especially theirs lateral third.

[Kissing nevus, a rare form of palpebral nevus--case report]. / Kissing naevus (divided naevus) o forma rara de nev nevocelular situat pe pleoape--prezentare de caz.

Kissing naevus is a rare form of congenital nevocellular naevus. We present the cases of three young girls. One of them was 9 years old and had an asymptomatic homogeneously pigmented round-oval naevus on the right eye and two girls (12 and 20 years old) who had the same kind of naevus of different sizes on the left eye, symmetrically situated on the two eyelids. The lower part of the naevus were bigger than the upper part in all the three cases. Histological they are compound or dermal nevus As treatment, ones recommend early excision, others contraindicates any surgical interventions.