Nodular Vasculitis That Developed during Etanercept (Enbrel) Treatment in a Patient with Psoriasis.

Nodular vasculitis was introduced by Montgomery for cases of erythema induratum-like lesions that were not associated with tuberculosis. Nodular vasculitis has been associated with both nontuberculous infections and noninfectious conditions. However, there has been no report on the development of nodular vasculitis during tumor necrosis factor-α inhibitor treatment. A 28-year-old man visited our clinic for the treatment of severe psoriasis with a 20-year history. Subcutaneous injection of etanercept (25 mg, twice weekly) was started. One year later, erythematous nodules developed on his lower leg. A skin biopsy showed lobular panniculitis with extensive necrosis and vasculitis. To exclude latent tuberculosis, an assay specific for Mycobacterium tuberculosis antigens was performed, with a negative result. After stopping etanercept under the diagnosis of nodular vasculitis associated with etanercept, the lesions gradually disappeared, leaving depressed scars in 3 months. There has been no recurrence after 6 months of follow-up.

Eruptive anetoderma in a patient with systemic lupus erythematosus.

Anetoderma is a rare cutaneous disorder characterized by a loss of normal elastic tissue that presents clinically as atrophic patches located mainly on the upper trunk. Recent studies suggest immunological mechanisms may play a role in this process. Furthermore, a secondary form of macular atrophy occurs in the course of infectious diseases (e.g. syphilis and tuberculosis) and autoimmune disease (e.g. systemic lupus erythematosus [SLE]). Here, we report the case of a 20-year-old woman previously diagnosed with SLE, who presented with numerous well-circumscribed atrophic macules on the face and upper trunk. Histopathological examination showed decreased elastic tissues in the reticular dermis and mononuclear cells adhering to elastic fibers, consistent with anetoderma. Thus, the eruptive anetoderma localized widely on the face and upper trunk may have been caused by an autoimmune response of SLE.

Effect of emollients containing vegetable-derived lactobacillus in the treatment of atopic dermatitis symptoms: split-body clinical trial.

BACKGROUND: Atopic dermatitis (AD) patients suffer from xerosis. Proper skin care, including the use of emollients, may help improve xerosis and minimize disease exacerbation. Lactobacillus sakei probio 65, isolated from the Korean vegetable-based product kimchi, can decrease interleukin 4 and immunoglobulin E levels and inhibit Staphylococcus aureus. Moreover, it has reportedly shown positive dermatological effects in both animal and clinical studies. OBJECTIVE: To compare the effects of an emollient that contains Lactobacillus (treated) with a normal emollient (control) on AD. METHODS: This double-blind, randomized, split-body clinical trial involved 28 patients with AD. The patients applied the Lactobacillus-containing emollient on one side of their body and the control emollient on the other side twice daily for 4 weeks. Trans-epidermal water loss (TEWL) and skin capacitance were evaluated and investigator global assessment and the visual analogue scale (VAS) were administered on weeks 0, 1, 2, and 4. RESULTS: The treated sides had significantly lower TEWL and VAS values and significantly higher skin capacitance values over time than the control sides. CONCLUSION: Topical application of Lactobacillus-containing emollients may improve the skin permeability of patients with AD.

A Novel Compound Rasatiol Isolated from Raphanus sativus Has a Potential to Enhance Extracellular Matrix Synthesis in Dermal Fibroblasts.

BACKGROUND: The fibrous proteins of extracellular matrix (ECM) produced by dermal fibroblast contributes to the maintenance of connective tissue integrity. OBJECTIVE: This study is carried out to identify the bioactive ingredient from natural products that enhances ECM production in dermal fibroblasts. METHODS: Bioassay-directed fractionation was used to isolate the active ingredient from natural extracts. The effects of rasatiol (isolated from Raphanus sativus) on ECM production in primary cultured human dermal fibroblasts was investigated by enzyme linked immunosorbent assay and western blot analysis. RESULTS: Rasatiol accelerated fibroblast growth in a dose-dependent manner and increased the production of type 1 collagen, fibronectin and elastin. Phosphorylation of p42/44 extracellular signal-regulated kinase, p38 mitogen-activated protein kinase, and Akt was remarkably increased by rasatiol, indicating that enhanced ECM production is linked to the activation of intracellular signaling cascades. CONCLUSION: These results indicate that rasatiol stimulates the fibrous components of ECM production, and may be applied to the maintenance of skin texture.

Regulation of lipid production by acetylcholine signalling in human sebaceous glands.

BACKGROUND: The extraneuronal cholinergic system has been implicated in numerous functions in the skin, such as terminal differentiation, barrier formation, sweat secretion and the microcirculation. However, the evidence for cholinergic signalling in sebaceous glands is lacking, and its role needs to be clarified. OBJECTIVE: We investigated the role of acetylcholine signalling in sebaceous glands using human sebocytes and a clinical study using botulinum toxin. METHODS: Immunohistochemistry and immunocytofluorescence were performed to evaluate cholinergic receptor levels in sebaceous glands. Lipid levels were assessed by Oil Red O staining and signalling pathways by Western blotting. To evaluate the clinical relevance, we also assessed the effect of botulinum toxin on sebum production in healthy volunteers. RESULTS: We demonstrated that human skin sebaceous glands in vivo and sebocytes in vitro express nicotinic acetylcholine receptor α7 (nAchRα7), and that acetylcholine increased lipid synthesis in a dose-dependent manner. When sebocytes were incubated with α-bungarotoxin, a competitive nAchR antagonist, acetylcholine failed to up-regulate lipid synthesis. Twenty healthy volunteers were enrolled in a double-blind, placebo-controlled, split-face study. A marked decrease in sebum production on the botulinum-treated side was found in volunteers with oily skin. CONCLUSION: These results provide evidence that acetylcholine signalling plays a significant role in human sebaceous gland biology and identify acetylcholine signalling as a promising target in the clinical management of disorders in which sebum production is increased, such as acne vulgaris.

The impact of implementing critical care team on open general intensive care unit.

BACKGROUND: There are a plethora of literatures showing that high-intensity intensive care unit (ICU) physician staffing is associated with reduced ICU mortality. However, it is not widely used in ICUs because of limited budgets and resources. We created a critical care team (CCT) to improve outcomes in an open general ICU and evaluated its effectiveness based on patients' outcomes. METHODS: We conducted this prospective, observational study in an open, general ICU setting, during a period ranging from March of 2009 to February of 2010. The CCT consisted of five teaching staffs. It provided rapid medical services within three hours after calls or consultation. RESULTS: We analyzed the data of 830 patients (157 patients of the CCT group and 673 patients of the non-CCT one). Patients of the CCT group presented more serious conditions than those of the non-CCT group (acute physiologic and chronic health evaluation II [APACHE II] 20.2 vs. 15.8, p<0.001; sequential organ failure assessment [SOFA] 5.5 vs. 4.6, p=0.003). The CCT group also had significantly more patients on mechanical ventilation than those in the non-CCT group (45.9% vs. 23.9%, p<0.001). Success rate of weaning was significantly higher in the CCT group than that of the non-CCT group (61.1% vs. 44.7%, p=0.021). On a multivariate logistic regression analysis, the increased ICU mortality was associated with the older age, non-CCT, higher APACHE II score, higher SOFA score and mechanical ventilation (p<0.05). CONCLUSION: Although the CCT did not provide full-time services in an open general ICU setting, it might be associated with a reduced ICU mortality. This is particularly the case with patients on mechanical ventilation.

Multiple miliary osteoma cutis: treatment with CO(2) laser and hook.

Miliary osteoma cutis refers to the variant of morphologically normal bone formation disorder in the dermis or subcutaneous tissue. The etiology of miliary osteoma cutis is still uncertain. But it may be due to osteoblastic metaplasia of mesenchymal elements. In our case, a healthy 55-year-old woman presented with multiple, skin-colored, non-tender, firm papules measuring 1 to 3 mm in diameter disseminated over the both cheeks for 3 years. We treated her with carbon dioxide (CO(2)) laser extraction with the hook through a small hole and patient had dramatic response to quick and simple treatment modality.

Tissue transglutaminase-induced down-regulation of matrix metalloproteinase-9.

Tissue transglutaminase (TGase 2) has been reported to have multiple functions in addition to its function as a biological adhesive. To identify its roles, we investigated the effects of TGase 2 on gelatinase activity. The MMP-9 activity of certain cell lines was significantly inhibited with retinoic acid treatment, and this effect was reversed in the presence of a TGase 2 inhibitor. Furthermore, TGase 2 overexpression reduced the MMP-9 protein expression levels and inhibited its activity in both culture media and cell lysate. The decreased mRNA levels of MMP-9 and the results of a promoter assay revealed that TGase 2 may be involved in MMP-9 transcription. Further, data obtained in an immunoprecipitation assay and an electrophoretic mobility shift assay demonstrated that TGase 2 binds to c-Jun and suppresses its binding activity toward AP-1. These results suggest that TGase 2 inhibits MMP-9 via downregulation of MMP-9 transcription activity by blocking the binding of the Jun-fos complex to an AP-1 site.