Vichy mineralizing water with hyaluronic acid is effective and well tolerated as an adjunct to the management of various dermatoses and after esthetic procedures.

INTRODUCTION: M89, containing 89% of Vichy mineralizing water and hyaluronic acid, has been developed to reinforce the skin barrier and to improve skin quality. AIM: To assess efficacy and tolerability of M89. METHOD: Observational survey of subjects with facial dermatoses or after esthetic procedures. M89 served as adjunct to conventional therapy. Clinician assessments of erythema, desquamation, irritation and patient-reported dryness, burning, itching, and stinging/tingling were conducted at baseline and 4 weeks. At 1 week and 4 weeks, patient assessed tolerance and satisfaction with M89. RESULTS: A total of 1630 subjects participated; 92.5% were females. Mean age was 41.1 ± 11.3 years. Dermatological indications accounted for 32.5%, procedures for 67.5%. At 4 weeks, in subjects with dermatoses, erythema had resolved or improved in 68.0%, desquamation in 83.4%, and irritation in 93.3%. Dryness, burning, itching, and stinging/tingling scores had decreased by 63.8%, 81.8%, 70.9%, and 85.2%, respectively (all P ≤ .0001); 75.7% considered that their skin was sufficiently hydrated. In the procedure group, erythema had resolved or improved in 72.5%, desquamation in 75.2%, and irritation in 88.1%. Dryness, burning, itching, and stinging/tingling scores had decreased by 62.1%, 78.8%, 70.0%, and 84.2%, respectively (all P ≤ .0001); 74.1% considered that their skin was sufficiently hydrated. Almost all subjects reported soothed skin and satisfaction with product texture. Subject and investigator satisfaction was very high. CONCLUSION: M89 significantly improves skin signs and symptoms after 4 weeks of continued use with no tolerance issues in subjects with dermatological indications. Moreover, subjects who have had recently undergone esthetic procedures M89 allowed a satisfying skin recovery.

[Rosacea: pathogenesis, clinical forms and therapy]. / A rosacea patogenezise, klinikai formái és kezelése.

Rosacea is one of the most common chronic dermatological diseases. It is characterized by transient or persistent facial erythema, teleangiectasias, papules and pustules, usually on the central portion of the face. Rosacea can be classified into four main subtypes: erythemato-teleangiectatic, papulopustular, phymatous, and ocular. These subtypes require different therapeutic approaches. Regarding to the pathomechanism, several hypotheses have been documented in the literature, including genetic and environmental factors, vascular abnormalities, dermal matrix degeneration, microorganisms such as Demodex folliculorum and Helicobacter pylori, but the cause of rosacea is still not known. Authors in this article review current literature on new classification system of rosacea, as well as the main pathogenetic theories and current therapeutic options.

Searching for foreign antigens as possible triggering factors of autoimmunity: Torque Teno virus DNA prevalence is elevated in sera of patients with bullous pemphigoid.

OBJECTIVE: The Torque Teno virus (TTV), a member of virus genus Anellovirus has been shown to be commonly present in humans, yet without detectable pathogenicity. Recent studies imply that TTV may contribute to provoke autoimmune progresses in systemic lupus erythematosus and idiopathic inflammatory myopathies. We aimed to study the presence of TTV in a group of patients with autoimmune bullous diseases with a further goal to identify long-lasting foreign antigen, such as TTV as possible triggers of skin-specific autoimmunity. PATIENTS AND METHODS: We performed in silico research to study similarities between known TTV sequences and antigens of bullous pemphigoid (BP), pemphigus vulgaris (PV) and dermatitis herpetiformis (DH). Basic Local Alignment Search Tool results showed matching regions for the major BP antigens BP180 and BP230, PV antigen desmoglein 3 and DH antigen transglutaminase 3 and disclosed overlapping, antigen-predicted sequences only for BP180 regions. We also assessed the prevalence of TTV in these disorders and compared them with the results from two healthy blood donor groups (group 1: sex- and age-matched for the general bullous group, n = 95; group 2: sex- and age-matched for BP, n = 50). Furthermore, we assayed lymphocytes from four TTV DNA and BP180 NC16A blot-positive BP patients and three controls in a standard lymphocyte transformation test with a TTV peptide from the conserved ORF(Open Reading Frame)1/N22 region. RESULTS: We found that the detection rate of TTV was comparable with that in healthy controls in the group of PV (19/33); whereas detection rates in DH showed a slight, but not significant tendency for elevation (17/20). Contrary, the TTV prevalence in BP patients was significantly elevated (group 1: 36/40 vs group 2: 31/50, P < 0.032). Lymphocytes from all four virus-positive BP patients heavily reacted to TTV peptide while two of the three healthy controls have shown not to recognize the viral sequences. Only the TTV carrier healthy control had a minor reaction at lowest peptide concentration. The combined in silico, polymerse chain reaction and in vitro cell assay data of the present study indicate that a TTV persistence may contribute to the pathogenesis of BP.

[Paraneoplastic pemphigus]. / Paraneoplasticus pemphigus.

Paraneoplastic pemphigus is an autoimmune bullous skin disease induced by underlying malignant or benign neoplasias. The diagnostic and immunological criteria of the disease were characterized by Anhalt et al. in 1990. Clinical symptoms are variable, consisting of polymorphous blistering skin eruption and severe, painful mucocutaneous ulcerations. In a subset of patients, only papular lesions develop, resembling lichen planus, or graft-versus-host disease; in some cases blisters may develop later. Severe dyspnea, progressive respiratory failure with clinical features of bronchiolitis obliterans is a rather frequent and severe complication. The diagnosis can be established with direct and indirect immunofluorescent studies and immunoblot analysis. The autoantigens identified to date include cytoplasmic proteins of the plakin gene family: envoplakin (210 kD), periplakin (190 kD), plectin (approximately 500 kD), desmoplakin I (250 kD), desmoplakin II (210 kD) and bullous pemphigoid antigen 1 (230 kD). The desmosomal cadherins: desmogleins 1 and 3, and desmocollins 2 and 3, as well as bullous pemphigoid antigen 2 (180 kD) and an undetermined 170-kD transmembranous antigen are also target autoantigens in the disease. The mortality rate is more than 90 percent. Beside treatment of the underlying tumor, a combination of systemic steroids with immunomodulators, cytostatic drugs, plasmapheresis, plasma exchange, intravenous gammaglobulin, or anti-CD20 monoclonal antibody (rituximab) may be the most appropriate treatment.

Tissue transglutaminase ELISA positivity in autoimmune disease independent of gluten-sensitive disease.

BACKGROUND: Our aim was to understand why some sera from patients with a broad spectrum of autoimmune diseases or non-autoimmune diseases involving enhanced apoptosis, cell lysis and/or putative secondary autoimmune processes show reactions in the tissue transglutaminase (TGc) ELISA used for diagnosis of gluten-sensitive disease. METHODS: Sera were compared from groups of patients with autoimmune diseases, diseases involving organ specific enhanced cell death, celiac disease or dermatitis herpetiformis, diseases of non-autoimmune origin, and a group without known disease. IgA antibodies against TGc were detected using human antigen (produced recombinantly in bacterial or human cells) in different systems (non-commercial ELISA with buffers of differing NaCl concentrations, and anti-TGc sandwich ELISA). Anti-gliadin and anti-endomysium antibodies were also determined. RESULTS: Many sera from patients with autoimmune disorders gave a positive signal in the human TGc ELISAs. The signal appeared related to minor impurities in the recombinant human TGc used and to raised serum IgA antibody levels rather than to the occurrence of TGc specific antibodies in these patients. CONCLUSIONS: No association of anti-TGc Abs and autoimmune conditions independent of gluten-sensitive disease could be shown. Care should be taken to exclude copurification of chaperones, like heat shock protein 70, where preparing antigens for TGc ELISAs.

Launois-Bensaude syndrome and Bureau-Barrière syndrome in a psoriatic patient: successful treatment with carbamazepine.

Authors report a 41-year-old male patient with multiple symmetric lipomatosis, who also had psoriasis. In addition he suffered from peripheral neuropathy, acro-osteolysis and malum perforans pedis fulfilling the criteria of Bureau-Barrière syndrome. Considering the severe peripheral neuropathy and the preliminary report on the efficacy of carbamazepine in psoriasis, a carbamazepine monotherapy was initiated for both indications. The psoriatic skin symptoms cleared within 6 weeks. The patient has continued this medication for 8 months without side effects. During that time his skin remained symptom free and the neuropathy has improved.