Neuroimmune Mediators of Pruritus in Hispanic Scalp Psoriatic Itch.

Scalp psoriatic itch is a common, bothersome, yet understudied, condition with numerous associated treatment challenges. The aim of this study was to enhance our understanding of the pathophysiology of scalp psoriatic itch. Immunohistochemical analysis of known neuroimmune mediators of pruritus was conducted using scalp biopsies from 27 Hispanic psoriatic patients. Patients were categorized into mild/moderate or severe itch groups according to their itch intensity rating of scalp itch. Protease activated receptor (PAR2), substance P, transient receptor potential (TRP)V3, TRPM8 and interleukin-23 expression all correlated  significantly with itch intensity. The pathophysiology of scalp psoriasis is largely non-histaminergic, mediated by PAR2, interleukin-23, transient receptor potential channels, and substance P.

Fibromodulin Gene Variants (FMOD) as Potential Biomarkers for Prostate Cancer and Benign Prostatic Hyperplasia.

By the year 2050, the world's elderly population may increase exponentially, raising the rate of disease characteristic of this group, such as prostate cancer (PCa) and benign prostatic hyperplasia (BPH). Prostate disorders have a multifactorial etiology, especially age and genetic factors. Currently, PCa is the second most frequent neoplasm in the male population worldwide. The fibromodulin gene encodes a small leucine-rich proteoglycan (SLRP) which acts in the collagen fibrillogenesis pathway, cell adhesion, and modulation of TGF-ß signaling pathways, which has been recently associated with PCa. The present study sequenced the coding region of the FMOD in a sample of 44 PCa, 90 BPH, and 82 controls from a Brazilian population, and the results identified 6 variants: 2 missenses (p.(Tyr42Ser) and p.(Pro24Ala)); 3 synonymous (p.(His253=), p.(Asn353=), and p.(Glu79=)); and 1 intronic (c.980-114A>G). Of these, p.(Tyr42Ser), p.(Pro24Ala), and p.(Asn353=) are rare variants, and p.(Tyr42Ser) was predicted as potential pathogenic by the algorithms used here, in addition to not being observed in controls, suggesting that may be a potential biomarker for development of PCa and BPH. In conclusion, we identified for the first time, in Brazilian individuals with PCa and BPH, a potentially pathogenic variant in the analysis of FMOD gene. Further studies are needed to investigate the deleterious effect of this variant on the structure and/or function of the FMOD protein.

Alexithymia in Patients with Psoriasis: A Cross-Sectional Study from Ecuador.

OBJECTIVE: We designed this study to determine the frequency of alexithymia in Ecuadorian patients with psoriasis, as well as possible associations between demographic factors, disease severity, and treatment adherence. METHODS: A cross-sectional study involving 99 Ecuadorian patients with psoriasis was conducted. Multinomial logistic regressions were performed to ascertain whether age, gender, educational level, years with disease, psoriasis area and severity index (PASI) scores, and treatment adherence categories are prediction factors in patients with psoriasis to present alexithymia, possible alexithymia or no alexithymia. RESULTS: A total of 99 patients participated in the study with a gender distribution of 57.6% male, and an average age and years with disease of 48.3 and 7.4, respectively. Out of all patients, 33.3% presented alexithymia, and 22.2% possible alexithymia, as assessed by the Toronto Alexithymia Scale (TAS-20). The multiple regression model statistically significantly predicted the TAS-20 score from age, gender, educational level, years with psoriasis, PASI score and level of adherence F (7,88) = 4.171, p = 0.001, adj. R2= 0.189. Only having the highest educational level added statistical significance to the prediction of having a lower TAS-20 score, whilst the remainder variables did not. CONCLUSION: We found a similar proportion of alexithymia, as well of average TAS-20 scores among Ecuadorian patients with psoriasis in comparison to previous studies. Only having the highest educational level was found to decrease the TAS-20 score. Age, gender, years with psoriasis, PASI score and level of adherence were not identified as factors that influence the TAS-20 score.

Chronic Localized Fibrosing Leukocytoclastic Vasculitis Associated With Lymphedema, Intralymphatic and Intravascular Lymphocytosis, and Chronic Myelogenous Leukemia: A Case Report of Unilateral Erythema Elevatum Diutinum.

One of the pathogenic causes of cutaneous inflammatory pseudotumors is chronic localized fibrosing leukocytoclastic vasculitis (CLFLCV), a vasculitic reaction pattern seen in granuloma faciale (GF), a localized vasculitis, and erythema elevatum diutinum (EED), a generalized vasculitis. Patients with myelodysplastic syndromes (MDSs) are at risk for a diverse spectrum of cutaneous neutrophilic dermatoses such as EED. Herein, we report a 74-year-old man who presented with a large ulcerative, fungating tumor affecting the right flexor ankle caused by CLFLCV. During his workup and management, MDS and Philadelphia chromosome-negative chronic myeloid leukemia was diagnosed. Surgical excision of the inflammatory mass promptly triggered tumor recurrence, whereas antineutrophil therapy (dapsone coupled with hydroxyurea, and prednisone) lead to tumor regression. Histopathologic examination revealed an eosinophilic-rich small-vessel neutrophilic vasculitis associated with storiform and angiocentric fibrosis (GF-like). In the regions of fibrosis, dilated lymphatic and vascular spaces were numerous, some of which were congested with small CD3-positive lymphocytes (intralymphatic and intravascular lymphocytosis). These findings indicate coexisting localized lymphedema. By direct immunofluorescence, IgM and C4d vessel deposits were detected. The pathogenesis of the fibrotic nodules and plaques of CLFLCV is suspected to be due to recurring bouts of immune-complex vasculitis, creating a cycle of vessel damage followed by reparative granulation tissue. Poor lymphatic drainage may be the underlying factor initiating and maintaining recurrent, localized episodes of immune-complex vasculitis and progressive fibrosis. Although his tumor histopathology resembled GF-eosinophilic rich CLFLCV-the clinical context points to a solitary and paraneoplastic case of EED.

Urticarial vasculitis induced by OTC diet pills: a case report.

BACKGROUND: Urticarial Vasculitis (UV) is in most of the cases idiopathic; however it has been associated with several conditions and drugs. Over the counter (OTC) diet pills are widely available, even on-line, but they are rarely regulated by pharmaceutical control. CASE PRESENTATION: We present the case of a 35-year-old female patient suffering of pruriginous and painful wheals more than 1 cm in diameter, with a burning sensation. The eruption lasted more than 24 hours and was accompanied by angioedema, headache and myalgia. No remarkable medical history was found, except for previous intake of OTC diet pills. UV diagnosis was confirmed by the skin biopsy of a lesion. CONCLUSION: OTC diet pills are widely available worldwide, and due to its widespread use, allergologists and dermatologist should be able to recognize symptoms and lesions of cutaneous vasculitis, which may be under reported.

Toxoplasmosis aguda en embarazadas asintomáticas de Rio de Janeiro, Brasil / Acute toxoplasmosis among asymptomatic pregnant women in Rio de Janeiro, Brazil

Objetivos: Determinar la frecuencia de toxoplasmosis aguda en mujeres embarazadas en la ciudad de Rio de Janeiro, Brasil. Material y métodos: Se incluyeron 2 673 mujeres embarazadas, asintomáticas para toxoplasmosis, durante el 2007. Se determinó IgM anti T. gondii en suero mediante inmunofluorescencia indirecta como diagnóstico de sensibilidad y la confirmación de los casos positivos por medio de ELISA. Se determinó el coeficiente de prevalencia. Resultados: Once (0,41%) tenían anticuerpos IgM anti-Toxoplasma gondii, con títulos iguales o mayores a 1:16. Conclusiones: La prevalencia de toxoplasmosis aguda en gestantes asintomáticas de la ciudad del Rio de Janeiro es baja, menor del promedio nacional de Brasil. (AU)

Objectives: To determine the frequency of acute toxoplasmosis among pregnant women in the city of Rio de Janeiro, Brazil. Methods: A total of 2673 asymptomatic pregnant women were included during 2007. IgM anti T. gondii was detected by indirect immunofluorescence, positive samples were confirmed by ELISA. Results: 11 (0,41%) pregnant women were IgM positive with titers of at least 1:16. Conclusions: Prevalence of acute toxoplasmosis among asymptomatic pregnant women in the city of Rio de Janeiro is low, lower that the overall prevalence in Brazil. (AU)

Rotavirosis en niños de la región de la Baixada Fluminense, Rio de Janeiro, Brasil / Rotavirosis in children from Baixada Fluminense region, Rio de Janeiro, Brazil

La infección por rotavirus es la principal causa de diarrea aguda en el mundo. Se estima que esta infección es responsable de aproximadamente 138 millones de casos de diarrea aguda y de 44 mil muertes al año en niños con edad menor de cinco años. Objetivos: Determinar la frecuencia de rotavirosis en niños con gastroenteritis atendidos en los servicios de salud de la región de la Baixada Fluminense. Material y métodos: Entre enero de 2009 y abril de 2010 se colectaron muestras fecales de 1067 niños menores de cinco años afectados de gastroenteritis. Se utilizó la técnica de reacción inmunocromatográfica para detectar antígenos de rotavirus (Rotavirus Tira Látex Test Bioeasy). Resultados: El 21,3% de los niños examinados tuvieron antígenos de rotavirus en las muestras fecales. No se encontró diferencias entre niños y niñas. Conclusiones: La incidencia de rotavirosis en la región de la Baixada Fluminense se encuentra en un nivel medio en comparación con poblaciones semejantes en países de Latinoamérica. (AU)

Rotavirus infection is the leading cause of acute diarrhea worldwide. It is estimated that this infection is responsible for approximately 138 million cases of acute diarrhea and 44 000 deaths per year in children less than five years of age. Objectives: To determine the frequency of rotavirus infection in children with gastroenteritis treated in health services in the Baixada Fluminense region. Methods: Between January 2009 and April 2010, 1067 fecal samples from children under five years of age with gastroenteritis were collected. We used the immune chromatographic technique to detect rotavirus antigens (Rotavirus Latex Test Strip Bioeasy). Results: 21.3 % of children tested had rotavirus antigen in stool samples. No differences were found between boys and girls. Conclusions: The incidence of rotavirus in the Baixada Fluminense region is at an average level compared to similar populations in Latin America. (AU)

Patología del dedo gordo / Pathology of the big toe

No es fácil el hallar en los textos magistrales de dermatología, capítulos específicos que traten sobre patología que tenga su asiento en el dedo gordo (hallux, 1er artejo o dedo grande), sin embargo, son lesiones de consulta frecuente en la práctica diaria. De diversas etiologías, congénitas o adquiridas, infecciosas, metabólicas o tumorales, todas ellas pueden producir alteraciones en suanatomía y funcionabilidad. A continuación, presentamos un esbozo de clasificación sencilla de estas enfermedades, basándonos en la patología observada en nuestro departamento, en su respectiva iconografía y además realizamos una descripción de cada una de ellas.

ItÆs not easy to find textbooks of dermatology with chapters dedicated specifically to pathologies that affect the big toe. However, they are a frequent reason for consultation in our practice. Multiple conditions of different etiologies (congenital, acquired, tumoral, infectious, metabolic, etc) can compromise theiranatomy and function. We present a simple classification of these pathologies based on the observed associated clinical conditions and its respective iconography. In addition a brief description of these affections is also presented.

Manifestaciones dermatoscópicas de procesos alopécicos en pacientes pediátricos / Dermoscopic manifestations of alopecic processes in pediatric patients

La dermatoscopía es una técnica muy útil no solo en lesiones melanocíticas sino también en otras alteraciones de diferente etiología. El pelo es asiento de variadas enfermedades que en muchas ocasiones dan origen a dudas diagnósticas. El examen dermatoscópico permite en unos casos magnificar claramente las lesiones que clínicamente ya son apreciables y en otros casos identifica signos propios de cada enfermedad que son una ayuda para el diagnóstico. En el presente estudio se revisan casos de patología capilar en niños y se escogen cuatro enfermedades con diagnóstico comprobado y con registro iconográfico tanto clínico como dermatoscópico: alopecia areata, tricotilomanía, tricorrexis nodosa localizada adquirida y tiña tricofítica. Se reportan las características dermatoscópicas capilares en cada enfermedad y se establecen patrones cuando esto es posible; finalmente se recomienda la aplicación de esta técnica en forma más amplia tanto por su bajo costo como por su fácil acceso (AU)

Dermatoscopy is a very useful technique not only for melanocytic lesions, but also for other cutaneous conditions of different etiology.The diagnosis of many disorders that affect hair and scalp can be challenging for the dermatologist. With the aid of the dermatoscopic examination, hair and scalp lesions that are observed clinically can be magnified, allowing us to identify certain signs and patterns that can help in the diagnosis.We describe the patterns of four hair disorders including, alopecia areata, trichotylomania, localized acquired trichorrhexis nodosa and tinea capitis. The charactheristic dermatoscopic findings, as well as the patterns that were observed in our patients are presented. Finally, due to its low cost and friendly use we suggest the application of this helpful tool to identify and diagnose the conditions described above (AU)