RESUMO
BACKGROUND: Psoriasis is a multifactorial immune-mediated inflammatory disease triggered by both genetic and environmental factors. The strong association between psoriasis and HLA-Câ06 allele has been demonstrated in various races. The HLA-Câ12 allele is closely related to the HLA-Câ06 family of alleles and shares identical sequences. To the best of our knowledge, there is no information about the relationship between HLA-Câ12 and psoriasis in the Turkish population. The present study aims to determine this relationship. METHODS: This case control study involved 150 patients with plaque-type psoriasis and 145 age- and gender-matched healthy individuals. Severity of psoriasis was measured using the PASI scores of all patients and joint involvement was investigated with CASPAR criteria. HLA-C alleles were determined with a Tepnel-Lifecodes system. RESULTS: HLA-Câ06, HLA-Câ12, and HLA-Câ04 alleles were most commonly observed in psoriasis patients. HLA-Câ06 and HLA-Câ12 were significantly more frequent in the psoriasis group. HLA-Câ06 was 4.11 times more common in psoriasis patients. An increase in PASI (Psoriasis Area Severity Index) scores was compatible with HLA-Câ12 positivity. A need for systemic treatment was highly noticeable in patients with the HLA-Câ12 allele. CONCLUSIONS: HLA-Câ12 was found as the second most frequent allele with psoriasis in Turkish population and was associated with severe psoriasis. Our study is limited as we could not investigate other potentially related alleles other than HLA-C alleles and risk factors increasing severity of psoriasis.
Assuntos
Alelos , Resistência à Doença/genética , Predisposição Genética para Doença , Antígenos HLA-C/genética , Psoríase/epidemiologia , Psoríase/genética , Idade de Início , Artrite Psoriásica/epidemiologia , Artrite Psoriásica/genética , Estudos de Casos e Controles , Frequência do Gene , Genética Populacional , Genótipo , Humanos , Vigilância da População , Medição de Risco , Fatores de Risco , Turquia/epidemiologiaRESUMO
BACKGROUND: Psoriasis is a chronic immune-mediated disease and treatment of psoriasis includes conventional immunosuppressive agents and biological agents. There are a few data on the relationship between psoriasis and melanocytic lesions. Either benign or malignant proliferations may be seen with immunosuppressive treatment. Eruptive nevi and malignant melanoma (MM) have been reported also associated with biological agents There is raising link biological treatment and malignancies. The objective of this paper is to examine the effects of biological agents versus conventional drugs on melanocytic nevi count and dermoscopical features. METHODS: Sixty-seven patients receiving TNF-α antagonists (etanercept, infliximab and adalimumab) and 62 patients receiving methotrexate and cyclosporin included to the trial. Duration of treatment with biological agents ranged from 6 months to 4 years, and between 6 months to 3 years for conventional drugs. Total and regional nevi count and structurel changes of biological treatment was evaluated. All melanocytic lesions checked for dermoscopic features by using Dermogenius Ultra (Linos Photonics GmbH & Co, Munich, Germany). Diagnosis of atypical nevi and doubtful lesions for melanoma was made by using ABCD clinically and, by three point check list (asymmetry, atypical pigment network and blue whitish structures) dermoscopically. RESULTS: There were no significant changes in number of total and regional nevi count and in the dermoscopic features of nevi between biological and conventional treatment groups. We observed dermoscopical changes in only one nevus of a patient receiving etanercept. Histopathological examination of this nevi confirmed the diagnosis of dysplastic nevi. There were no MM and non-melanoma skin cancers in both groups. CONCLUSIONS: We did not observe significant changes in biological and conventional treatment groups there is a need for further studies to determine long-term effects of biological agents on the melanocytic lesions in patients with psoriasis.
Assuntos
Fármacos Dermatológicos/uso terapêutico , Dermoscopia/métodos , Imunossupressores/uso terapêutico , Nevo Pigmentado/patologia , Psoríase/tratamento farmacológico , Adalimumab/efeitos adversos , Adalimumab/uso terapêutico , Adolescente , Adulto , Idoso , Criança , Fármacos Dermatológicos/efeitos adversos , Etanercepte/efeitos adversos , Etanercepte/uso terapêutico , Feminino , Humanos , Imunossupressores/efeitos adversos , Infliximab/efeitos adversos , Infliximab/uso terapêutico , Masculino , Melanócitos/patologia , Pessoa de Meia-Idade , Estudos Prospectivos , Psoríase/patologia , Fatores de Tempo , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto JovemRESUMO
Dermoscopy plays an important role in the diagnosis of pigmented lesions, particularly in the differential diagnosis of early-stage melanoma. Dermoscopy systems that aim to enable automatic "unmanned-without physician" diagnosis are becoming increasingly common. We aimed to investigate the reliability and weaknesses of diagnosis programs. Furthermore, we attempted to determine whether such programs are superior to diagnosis by a physician, compared to histopathological assessment. The images stored in the DermoGenius ultra-computerized dermoscopy system of the Dermoscopy Unit between January 2008 and December 2008 were surveyed retrospectively. Dermoscopic images made prior to excision of 77 lesions from 51 patients verified by histopathology were reviewed. Nineteen patients were men and 32 were women. Mean age was 35.5 years. Diagnosis by a clinician or automatic analysis revealed that 23 (30%) of the lesions were atypical (dysplastic) nevi, 22 (29%) were compound nevi, 10 (13%) were dermal nevi, 8 (10%) were malignant melanomas, 7 (9%) were common nevi, 6 (7%) were junctional nevi, and 1 (1%) was a blue nevus. Compared to histopathological diagnosis, considered the gold standard, the sensitivity of the automated analysis program was 96.6%, its specificity 14.9%, and its diagnostic accuracy 47%. For the clinician, the values were 100% for sensitivity, 66.7% for specificity, and 95% for diagnostic accuracy. Based on histopathological results, the diagnostic accuracy of the physician was higher than that of the automatic analysis program. Therefore, errors are inevitable when an inexperienced physician assesses patients according to automatic program results.
Assuntos
Dermoscopia/instrumentação , Melanoma/diagnóstico , Nevo Pigmentado/diagnóstico , Lesões Pré-Cancerosas/diagnóstico , Neoplasias Cutâneas/diagnóstico , Adulto , Automação , Competência Clínica , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Melanoma/patologia , Nevo Pigmentado/patologia , Lesões Pré-Cancerosas/patologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Neoplasias Cutâneas/patologiaAssuntos
Carcinoma de Células Escamosas/etiologia , Epidermólise Bolhosa/complicações , Neoplasias Esofágicas/etiologia , Alopecia/complicações , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/patologia , Epidermólise Bolhosa/genética , Neoplasias Esofágicas/genética , Neoplasias Esofágicas/patologia , Estenose Esofágica/etiologia , Evolução Fatal , Feminino , Genes Recessivos , Humanos , Pessoa de Meia-Idade , Doenças da Unha/etiologia , Doenças da Unha/patologiaRESUMO
Pustulotic arthro-osteitis, first described by Sonozaki, is a relatively rare disorder. Its prevalence is however probably underestimated in dermatological literature. Early recognition of the signs can prevent misdiagnosis. We describe a Turkish patient who presented with palmoplantar pustulosis and involvement of the sternoclavicular joint and peripheral oligoarthritis.
RESUMO
CD4+/CD56+ hematodermic neoplasm (blastic plasmacytoid dendritic cell neoplasm) involving the skin is relatively rare and has been of significant interest in the recent literature. We report here a 64-year-old male who presented with multiple purple-red nodules and plaques on his face, back, and chest. Histological examination of skin biopsies showed an intense hematolymphoid infiltration in the dermis and in the subcutaneous tissue. Stains were positive for CD4 (weak), CD56, and terminal deoxynucleotidyl transferase (TdT). These cells were negative for CD2, CD3, CD5, CD10, CD20, CD30, CD68, and T cell intracellular antigen (TIA). In situ hybridization (ISH) for Epstein-Barr virus was negative and the diagnosis was blastic NK cell lymphoma. The patient was treated with a hyper-CVAD regimen (cyclophosphamide, vincristine, doxorubicine, dexamethasone, methotrexate, and cytarabine).This treatment regimen achieved partial remission but the patient died eight months after the diagnosis. The patient presented with exclusively cutaneous involvement at the beginning but progressed rapidly and died shortly after despite aggressive chemotherapy. Due to its rarity, we present here a case of CD4+/CD56+ hematodermic neoplasm.
Assuntos
Antígenos CD4/imunologia , Antígeno CD56/imunologia , Linfoma Cutâneo de Células T/patologia , Neoplasias Cutâneas/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ciclofosfamida/uso terapêutico , DNA Nucleotidilexotransferase/análise , Células Dendríticas/imunologia , Células Dendríticas/patologia , Dexametasona/uso terapêutico , Doxorrubicina/uso terapêutico , Evolução Fatal , Humanos , Linfoma Cutâneo de Células T/tratamento farmacológico , Linfoma Cutâneo de Células T/imunologia , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/imunologia , Vincristina/uso terapêuticoAssuntos
Anti-Inflamatórios/uso terapêutico , Antifúngicos , Diflucortolona/análogos & derivados , Miconazol/análogos & derivados , Tinha/tratamento farmacológico , Administração Cutânea , Adulto , Anti-Inflamatórios/administração & dosagem , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Diflucortolona/administração & dosagem , Diflucortolona/uso terapêutico , Combinação de Medicamentos , Quimioterapia Combinada , Virilha/patologia , Humanos , Masculino , Miconazol/administração & dosagem , Miconazol/uso terapêutico , Pele/patologia , Tinha/diagnóstico , Resultado do TratamentoRESUMO
The aim of this study is to investigate the relationship of the plasma D-Dimer (D-d) level and the severity of the pneumonia in patients who have not any disease that may increase the D-d level, but pneumonia. This is prospective controlled study. Using the ATS 2001 Community Acquired Pneumonia (CAP) Guideline we divided the patients into two groups [severe (n= 14) and non-severe (n= 37) CAP] and looked for any significant difference in D-d levels with ELISA method among the patients groups and control group. Plasma D-d levels were 2438 +/- 2158 ng/mL in severe CAP group, 912.6 +/- 512.6 ng/mL in non-severe CAP group and 387 +/- 99.56 ng/mL in the control group. Patients with non-severe CAP and those with severe CAP group both showed an increase in plasma levels of D-d compared to control group (p< 0.05, p< 0.001, respectively). We also found that the severe CAP group had increased in plasma levels of D-d compared to the non-severe CAP group (p< 0.001). Plasma D-d level increases significantly in patients with CAP compared to control group. Plasma D-d levels increases significantly with the severity of the CAP.