Serum Levels of Tumor Necrosis Factor - alpha in Patients With Psoriasis.

Background: Psoriasis can be described as a T-cell-mediated disease, with a complex role for variety of cytokines and other factors. Among the inflammatory molecules influencing the keratinocites, TNF-α appears critical in sustaining most of the clinical manifestations of psoriasis. It is postulated that changes in cytokine production both locally and systemically could be useful in monitoring disease activity. Objective: The aim of the study was to evaluate serum levels of tumor necrosis factor alpha (TNF-α) in patients with psoriasis and the healthy subjects, and also to assess a possible association between TNF-α, clinical type and severity of disease. Methods: We studied the levels of serum TNF-α in 60 patients with psoriasis and in the serum of helthy 20 controls. According to the clinical type of disease, patients with psoriasis were divided into four groups: chronic plaque psoriasis (CPP), erythrodermic psoriasis (EP), pustular psoriasis (PP) and psoriatic arthritis (PA). Blood samples were collected from all psoriasis patients and from healthy control subjects. Serum level of TNF-α were measured by an enzyme-linked immunosorbent assay (ELISA) technique. The severity of CPP was assessed by Psoriasis Area and Severity Index (PASI). Results: Serum levels of TNF-α in patients with psoriasis were significialy higher than in the control group (3.25+1.74 pg/mL vs 0.20+0.01pg/mL, respectively). Significantly elevated serum TNF-α was in patients with PP type (7.39+6.92 pg/mL). There was statistically significant difference between the mean level of TNF-ɑ compared to the clinical type of psoriasis (p<0.05). The mean PASI score in patients with CPP was 0.56±12.45. It was not found statistically significant correlation between serum level of TNF-ɑ and PASI score in patients with CPP (p>0,05). Conclusion: Our results have demonstrated the imortance of determining serum levels of TNF-ɑ in patients with psoriasis. Further investigations are required to clarify the pathogenic role and clinical significance of TNF-ɑ, and these findings may provide important clues to assist in the development of new therapeutic strategies for patients with psoriasis.

A Clinical Study of Basal Cell Carcinoma.

INTRODUCTION: Basal cell carcinoma (BCC) is a non-melanocytic skin malignancy arising from basal cells of epidermis or follicular structures. Etiology of BCC is a multifactorial combination of genotype, phenotype, and environmental factors. There are several clinical variants of BCC including nodular, cystic, superficial, morphoeic, keratotic, pigmented and micronodular. AIM: The aim of our study was to analyze the recent clinical trends of basal cell carcinoma by reviewing a single institution's experience. METHODS: Total number of 422 patients clinically diagnosed with basal cell carcinoma were included in the study. Data on age, gender, skin type, personal and family history, duration of disease, localization of lesions, clinical type of lesions, and recurrence rate were collected and analyzed. The data were statistically evaluated. RESULTS: More than 80% of all BCC's were located on sun-exposed skin areas (p<0.05).The male /female ratio was 1:0.92. The nodular BCC was the most frequent type (59.2%), followed by the superficial (16.1%), pigmented (15.2%) and morphoeic (9.5%) types. The nodular and pigmented types were predominant located on the head and neck, whereas the trunk was the most common location for the superficial type (p<0.05). The tumor is commonly found in concomitance with skin lesion related to chronic sun exposure, such as actinic keratoses, solar lentigines and facial telangiectasia. During this study period, 41 cases showed recurrence of the cancer as the overall recurrence rate was 9.7%. There were no cases with metastasis or fatal outcome. CONCLUSIONS: The factors related to the development of BCC were older age and exposure to ultraviolet rays both in recreational and in occupational form. The prevention of BCC is based on the knowledge of risk factors, early diagnosis and treatment, particularly in susceptible populations.

Analysis of Epicutaneous Patch Test Results in Patients with Contact Dermatitis.

BACKGROUND: Allergic contact dermatitis (ACD) is a delayed type of hypersensitivity from contact with a specific allergen to which the patients has developed a specific sensitivity. The aim of the study was to evaluate the results of epicutaneous patch testing with standard series of contact allergen in patients suspected to have ACD. METHODS: 355 cases of ACD were included in the study. Test substances were applied on the upper part of the patient's back, on clinically uninvolved and untreated skin. All patients were free from therapy with oral antihistamines, steroids and immunosuppressants. The patch test was removed and reaction were evaluated after 48 h and 72 h. Grading of negative (-) to positive (+ to ++++) patch test was done according to the International Contact Dermatitis Research Group. Statistical data analysis was performed by using χ2-test. RESULTS: Of the 355 cases, 146 patients were male (41.1%) and 209 were female (58.9%). The youngest patients in the study was 16 years of age and the oldest was 67 years of age. The commonest age group affected was 41-50 years. Hands were the most common site of involvement. The occupational character of skin lesions was find in 75 (21.1%). The most common positive reactions were recorded to nickel sulphate 99 (27.8%), cobalt chloride 46 (12.9%), thimerosal 31 (8.7%), colophony 23 (6.5%), carba mix 21 (5.9%), potassium dichromate 20 (5.6%), acid chromici 19 (5.3%), fragrance mix 18 (5%), balsam of Peru 13 (3.7%), formaldehyde 9 (2.5%), and other allergens 26 (7.3%). Females were significantly more likely to show a positive response to two or more allergens (p<0.05). There was no statistically significant impact of age, occupation and duration of disease on results of patch testing (p>0.05). CONCLUSIONS: Our results indicate that nickel sulphate, cobalt chloride and thimerosal are the most common allergens responsible for induction of ACD. These findings are crucial in the treatment, long term management, an education of patients with ACD.

Serum Levels of Interleukin-2 in Patients with Alopecia Areata: Relationship with Clinical Type and Duration of the Disease.

BACKGROUND: Alopecia areata (AA) is a disease characterized by focally, nonscarring hair loss on the scalp or any hair-bearing surface. The etiology is unknown, although the evidence suggests that AA is an immunologically mediated disease. In the pathogenesis of AA, Th1 immune response is predominant. A special cytokine profile is created by Th1 cells, which disturbs the natural balance of the cytokine networks and leads to inflammatory reaction and follicle damage. OBJECTIVE: The aim of our study was to evaluate serum concentrations of IL-2 in patients with AA and healthy subjects. We also examined a possible association between serum levels of IL-2, disease severity, and duration of AA. METHODS: Sixty patients with AA and 20 healthy controls were enrolled in the study. Serum concentrations of IL-2 were measured using enzyme-linked immunoassay techniques. RESULTS: Comparison of mean values of IL-2 has showed that serum concentrations of this cytokine are significantly higher in serum samples of AA patients in relation to the control group (22.2 ± 1.19 vs. 21.1 ± 2.68 pg/mL, respectively; p = 0.0142). No correlations were found between clinical type, duration of the disease, and serum levels of IL-2. CONCLUSION: Our findings support the evidence that elevation of serum IL-2 is associated with AA. The exact role of serum IL-2 in AA should be additionally investigated in future studies.

Thyroid Autoimmunity in Patients with Chronic Urticaria.

INTRODUCTION: chronic urticaria (CU) is a skin disorder characterized by transient, pruritic wheals persisting for longer than 6 weeks. The etiopathogenesis of the disease is still unclear, but there is evidence that autoimmunity and endocrine dysfunction may be involved. AIM: the aim of this study was to determine whether chronic urticaria is statistically associated with thyroid autoimmunity. PATIENTS AND METHODS: in a prospective case-control study, we compared the frequency of thyroid auto-antibodies (thyroglobulin antibody, anti-Tg and thyroid peroxidase antibody, anti-TPO) in 70 patients with chronic urticaria and in 70 healthy volunteers. Thyroid auto-antibodies and thyroid hormones (thyroxine (T4), triiodthyronine (T3) and thyroid stimulating hormone (TSH) were measured in all subjects. RESULTS: thyroid functional abnormalities were found in 8 (11.43%) patients. Anti-Tg and anti-TPO were positive in 16 (23%) and 21 (30%) patients, respectively. In control group, only one subject (1.42%) had abnormalities in thyroid hormonal status, and two subjects (2.86%) had positive thyroid auto-antibodies. Compared with the control group, the frequency of both anti-Tg and anti-TPO was significantly higher in those with chronic urticaria (P < 0.05). CONCLUSION: this study shows a significant association between chronic urticaria and thyroid autoimmunity, and that tests to detect thyroid auto-antibodies are relevant in patients with chronic urticaria.

Prevalence of Candida Species in Patients with Psoriasis.

Investigation of Candida yeast prevalence in patients with psoriasis has been performed with the aim of determining their possible role as a trigger factor in the pathogenic process of this disease. The purpose of our study was to investigate the prevalence of Candida species on the skin of intertriginous areas and psoriasis lesions as well as the prevalence of Candida species in the stool of patients with psoriasis. This study also examines a possible correlation between the severity of psoriasis and prevalence of isolated Candida species. The patients with psoriasis were divided into two groups according to the clinical type of psoriasis; a group with plaque psoriasis (PP) and psoriasis inversa (PI) (G1) and a group with psoriasis erythrodermica (PE) and psoriasis pustulosa (PPS) (G2). The group of patients with PP and PI (G1) was divided according to score on the Psoriasis Area Severity Index test (PASI) according to severity of disease into the clinical subgroup with PASI <50 and another subgroup with PASI >50. Mycological analysis of skin samples in patients of the clinical group with PP and PI showed a statistically significant difference as well as correlation between the results of isolated specimens of Candida species from the skin of intertriginous areas and psoriasis lesions, the clinical form of psoriasis, and the PASI score.

TrichoScan findings in patients with effluvium capillorum.

Effluvium capillorum is a form of nonscarring alopecia characterized by diffuse hair shedding. This condition occurs when the normal balance of hairs in growth and rest phases is disrupted. Trichoscan is a computerized program used for digital measurement of hair growth and hair loss. This study was performed to describe the TrichoScan as a method, which combines standard epiluminiscence microscopy with automatic digital image analysis for the measurement of human hair. The study included 30 patients with effluvium capillorum (16 women and 14 men). A control group consisted of 30 generally healthy patients (14 women and 16 men). For the measurement of hair density and anagen/telogen ratio, a commercially available software (TrichoScan) was used. The results of digital image analysis from the patients showed a highly increased proportion of telogen hair roots. The authors' results indicate that TrichoScan represents a very useful tool in the evaluation of hair loss.

Vitiligo and autoimmunity.

BACKGROUND: Vitiligo is an acquired skin disorder characterized by depigmented maculae resulting from a reduction of the number and function of melanocytes. The etiopathogenesis of the disease is still unclear, but there is evidence that autoimmunity may be involved. OBJECTIVE: The aim of this study was to determine the prevalence and significance of antinuclear (ANA) and thyroid peroxidase (anti-TPO) antibodies in patients with vitiligo and control group. METHODS: In a prospective case-control study, we compared the frequency of antibodies (ANA and anti-TPO) in 40 patients with vitiligo and in 40 healthy volunteers. RESULTS: ANA were positive in 7 (17%) patients, which was insignificantly higher than control group, 2 (5%). Anti-TPO were positive in 11 (27%) patients. In control group, only two subjects (5%) had positive anti-TPO. Compared with the control group, the frequency anti-TPO were significantly higher in those with vitiligo (p < 0.05). CONCLUSION: Our findings show a significant association between vitiligo and thyroid autoimmunity, and that tests to detect anti-TPO are useful markers in patients with vitiligo. In contrary, ANA seems to have limited diagnostic relevance in routine clinical practice. Additional studies of a wider sample are warranted to confirm these findings and allow a detailed analysis.

Association between Vitiligo and Thyroid Autoimmunity.

Background. Vitiligo is a common skin disorder characterized by macular depigmentation of the skin. The etiopathogenesis of the disease is still unclear, but there is evidence that autoimmunity and endocrine disfunction may be involved. Objective. The aim of this study was to determine whether vitiligo is statistically associated with thyroid autoimmunity. Method. In a prospective case-control study, we compared the frequency of thyroid autoantibodies (thyroglobulin antibody, anti-Tg and thyroid peroxidase antibody, and anti-TPO) in 33 patients with vitiligo and in 33 healthy volunteers. Thyroid autoantibodies and thyroid hormones (thyroxine (T4), triiodothyronine (T3), and thyroid stimulating hormone (TSH) were measured in all subjects. Results. Thyroid functional abnormalities were found in 6 (18.18%) patients. Anti-Tg and anti-TPO were positive in 9 (27.27%) and 8 (24.24%) patients, respectively. In control group, only one subject (3.03%) had abnormalities in thyroid hormonal status, and two subjects had positive thyroid autoantibodies. Compared with the control group, the frequency of both anti-Tg and anti-TPO was significantly higher in those with vitiligo (P < .05). Conclusion. This study shows a significant association between vitiligo and thyroid autoimmunity, and that tests to detect thyroid autoantibodies are relevant in patients with vitiligo.

Serum levels of total immunoglobulin E in patients with psoriasis: relationship with clinical type of disease.

Psoriasis is a common cutaneous disorder characterized by inflammation and abnormal epidermal proliferation. Its severity ranges from a chronic plaque psoriasis (CPP) to generalized psoriatic erythroderma (PE). The cause of psoriasis is unknown although most evidence supports the hypothesis that psoriasis is an immunologically mediated disease. The aim of the study was to compare serum levels of total immunoglobulin E (IgE) between patients with psoriasis and healthy subjects, and to asses the difference between localized form (CPP) and extensive form of disease (PE). Fifty patients with psoriasis and 30 healthy subjects were included in this study. Serum levels of IgE were measured using nephelometric method. Serum levels of total IgE were significantly higher in patients than in controls (42% vs 10%; p < 0.05). The exact role of serum IgE in psoriasis should be additionally investigated in future studies.