A preliminary study about neurofilament light chain and tau protein levels in psoriasis: Correlation with disease severity.

BACKGROUND: Studies investigating cognitive dysfunction in psoriatic patients remain inconclusive. OBJECTIVE: To investigate the risk of cognitive decline in plaque-type psoriasis patients. METHODS: Serum neurofilament light chain (NFL) and tau protein concentrations in 45 patients with plaque-type psoriasis and forty-five healthy controls were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: Mean homeostasis model assessment (HOMA-IR) values (6.82 vs 3.25) and serum levels of insulin (28.19 vs 15.71), NFL (5.74 vs 1.98), and tau (348.17 vs 207.30) in patients with psoriasis were found to be significantly higher than those of in healthy controls. There was a significant positive correlation between NFL and tau (r = .257, P = .015). There was significant correlation between NFL, tau and PASI (r = .310, P = .040) and (r = .383, P = .010), respectively. Significant correlations between NFL and insulin, TC, HDL-C, TG, VLDL-C, and BMI were found. NFL (9.38 vs 3.08) and tau (439.28 vs 281.58) concentrations and PASI values (23.94 vs 14.18) in patients with disease onset before 40 years were significantly higher than that of the patients with disease onset after 40 years. C-reactive protein (CRP) was significantly correlated with BMI (r = .449, P < .001), LDL-C (r = .240, P = .026), TG (r = .244, P = .024), and VLDL-C (r = .241, P = .025) in patients with psoriasis. CONCLUSIONS: Increased serum NFL and tau protein levels and the presence of positive correlations between NFL, tau protein and PASI score show cognitive decline risk may be higher in moderate-to-severe psoriasis.

Serum Visfatin, Fetuin-A, and Pentraxin 3 Levels in Patients With Psoriasis and Their Relation to Disease Severity.

BACKGROUND: Psoriasis is a chronic immune-mediated inflammatory skin disease associated with increase of some pro-inflammatory mediators. We wanted to investigate whether there is a relationship between psoriasis and visfatin, fetuin-A and pentraxin 3 (PTX3)-pro-inflammatory mediators implicated in the development of insulin resistance (IR), metabolic syndrome, and atherosclerosis. METHODS: Visfatin, fetuin-A, and PTX3 concentrations were measured in 45 patients with plaque-type psoriasis and 45 healthy controls using enzyme-linked immunosorbent assay (ELISA). RESULTS: Serum levels of visfatin, fetuin-A, and PTX3 in patients with psoriasis were found to be higher than in healthy controls (P = 0.002, P = 0.009, P < 0.001, respectively). Psoriasis area and severity index (PASI) score correlated significantly with visfatin and fetuin-A levels (P = 0.011, P = 0.040, respectively). There was a significant positive correlation between visfatin and fetuin-A (P < 0.001). PTX3 levels were correlated positively with homeostasis model assessment (HOMA-IR), insulin, triglyceride (TG), and very low density lipoprotein cholesterol (VLDL; P = 0.009, P = 0.007, P = 0.023, P = 0.024, respectively). CONCLUSIONS: Increased serum visfatin, fetuin-A, and PTX3 levels, and the presence of positive correlation between visfatin, fetuin-A, and PASI score, probably reflect the inflammatory state and IR seen in psoriasis.

The effects of a high glycerin content hydrogel premolded mask dressing on post-laser resurfacing wounds.

BACKGROUND: Laser resurfacing for the rejuvenation of facial skin remains a popular cosmetic procedure. Postoperative care for laser resurfacing is important to optimize healing, reduce pain and minimize complications. OBJECTIVE: To compare the efficacy of the new dressing against placebo (Vaseline® cream) after Er:YAG laser resurfacing. METHODS: Fifteen patients between 45 and 72 years of age with facial wrinkles were enrolled in the study. Patients underwent full-face Er:YAG procedures. The wounds were then dressed: one side of the face was treated with Vaseline and the other with a hydrogel dressing. Erythema, edema, pigmentation, average time of re-epithelization, pain score, itching, clinical evaluation of infection, crust formation and acidity were documented. RESULTS: The hydrogel dressing decreased postoperative morbidity. The site treated by hydrogel showed a shorter epithelial healing time than the Vaseline site. The dressing relieved the immediate pain of facial resurfacing as well as preventing crust formation and itching. CONCLUSION: A hydrogel dressing is a better and suitable alternative to the open technique to manage post-laser wound healing.

Conjunctival papilloma caused by human papillomavirus type 11 treated with systemic interferon in a five-year-old boy.

Conjunctival papilloma is a benign tumor of the conjunctival mucosa. In childhood, papilloma represents 7-10% of conjunctival tumors. Human papillomavirus (HPV)-6 and HPV-11 are the major HPV types responsible for conjunctival lesions. A five-year-old boy with a two-year history of conjunctival papilloma caused by HPV type 11 treated with systemic interferon alpha is reported and the literature is reviewed.

Nicolau syndrome and perforator vessels: a new viewpoint for an old problem.

Nicolau syndrome is rare cutaneous adverse reaction following injection of various drugs. The disease has been associated with almost all classes of medications, such as nonsteroidal anti-inflammatory drugs, local anesthetics, corticosteroids, antibiotics, vitamin B complexes, antihistamines, and vaccines. The most severe cases of this complication occur after injection of nonsteroidal anti-inflammatory drugs. Subcutaneous injection is an important factor in the pathogenesis of the syndrome. We report a case of Nicolau syndrome resulting from intramuscular injection of diclofenac and discuss some precautions to prevent this complication.

Vanishing bile duct and Stevens-Johnson syndrome associated with ciprofloxacin treated with tacrolimus.

Stevens-Johnson syndrome (SJS) is a serious and potentially life-threatening disease. Vanishing bile duct syndrome (VBDS) is a rare cause of progressive cholestasis. Both syndromes are mostly related with drugs. We report a case of a patient with ciprofloxacin-induced SJS and acute onset of VBDS, and reviewed the related literature. It is the first case of ciprofloxacin-induced VBDS successfully treated with tacrolimus. This case reminds physicians of the importance of drug reactions, their severity, techniques for diagnosis and methods of management.

The Effect of Long-Pulsed Nd:YAG Laser for the Treatment of Onychomycosis.

BACKGROUND: Topical onychomycosis therapies are usually inadequate, and patient compliance to systemic therapies is poor. Recently, interest in laser therapy for the treatment of onychomycosis has increased. We sought to investigate the efficacy of long-pulsed Nd:YAG laser therapy for onychomycosis. METHODS: Thirty patients with mycologically confirmed onychomycosis received long-pulsed 1064-nm Nd:YAG laser therapy, moving the beam in a spiral pattern over the whole nail plate two times, with a 1-minute pause between passes. Laser therapy was performed with a spot diameter of 4 mm at a speed of 25 mm/sec once weekly for 4 weeks using fluencies ranging from 40 to 60 J/cm2, depending on the thickness of the nail plate. Patients were evaluated in terms of clinical improvement and mycologic cure. RESULTS: Thirty patients started and 15 completed the study. Mycologic cure was achieved in nine patients (60%), of whom eight (89%) were infected with Trichophyton sp. Complete clinical improvement was achieved in seven patients (47%), all of whom were infected with Trichophyton sp. Mycologic cure was not achieved in one of two patients infected with Epidermophyton or in either patient in whom the agent was Candida or Aspergillus; complete clinical improvement did not occur in any of these patients. No serious adverse events were observed. CONCLUSIONS: Based on these results, long-pulsed Nd:YAG laser can be used as an effective treatment for onychomycosis, but further studies are needed to draw firmer conclusions.

Fibroblast Growth Factor 23 and Placental Growth Factor in Patients with Psoriasis and their Relation to Disease Severity.

PURPOSE: Psoriasis is an immune-mediated skin disease characterised by accentuated keratinocyte proliferation, hyperkeratinisation, leukocyte and T-lymphocyte chemotaxis, and neoangiogenesis. Chronic inflammation, imbalance between pro- and anti-inflammatory cytokines, and many angiogenic mediators has been implicated in the disease etiopathogenesis. The aim of this study was to investigate whether psoriasis is related to fibroblast growth factor 23 (FGF23) and placental growth factor (PLGF) - mediators related to insulin resistance (IR), metabolic syndrome, and atherosclerosis. MATERIALS AND METHODS: Forty five patients with plaque type psoriasis and forty five healthy controls were included in the study. Serum FGF23 and PLGF concentrations were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: Mean homeostasis model assessment (HOMA-IR) values and serum levels of insulin, FGF23 and PLGF, in patients with psoriasis were found to be higher than those of in healthy controls (p= 0.001, p=0.001, p=0.001 and p=0.003 respectively). Psoriasis area and severity index (PASI) score correlated significantly with PLGF levels (p=0.039). There was a significant positive correlation between FGF23 and PLGF (p<0.001). CRP was significantly correlated with BMI (p=0.019), glucose (p=0.017), TC (p=0.043), TG (p=0.003), and VLDL-C (p=0.004) in patients with psoriasis. CONCLUSIONS: Increased serum FGF23 and PLGF levels and the presence of positive correlation between PLGF and PASI score probably reflects the inflammatory state and IR seen in psoriasis. Above mentioned correlations provide rationale for possible application of serum FGF23 and especially of PLGF measurements as biomarkers of disease severity, which could be useful for management of treatment efficacy.

Treatment Outcomes of Long-Pulsed Nd: YAG Laser for Two Different Subtypes of Rosacea.

BACKGROUND: A variety of lasers have been used for the treatment of rosacea. However, treatment of this condition with long-pulsed neodymium-doped yttrium aluminium garnet laser has not been reported yet. OBJECTIVE: To assess the efficacy and safety of long-pulsed neodymium-doped yttrium aluminium garnet laser in two different subtypes (erythematotelangiectatic and papulopustular) of rosacea. METHODS: A total of 66 patients were enrolled in the study. All of the patients were treated with long-pulsed neodymium-doped yttrium aluminium garnet laser with 3- to 4-week intervals. Rosacea severity score was assessed by using photographs. Improvement in severity was defined as the percentage reduction in severity scores from baseline to the end of treatment. Patients were also asked about their own opinions of improvement at the end of the treatment. Side effects were also documented. RESULTS: Good to excellent improvement was achieved in up to 50 percent of the patients in the erythematotelangiectatic and papulopustular groups. Percent improvement of global severity was significantly greater in the erythematotelangiectatic patients than in the papulopustular patients. The majority of patients from both groups noted a significant improvement of the lesions. Hypopigmented atrophic scars were seen in two patients. CONCLUSION: The long-pulsed neodymium-doped yttrium aluminium garnet laser is a safe and effective treatment for vascular and inflammatory lesions of rosacea.

G-231A and G+70C Polymorphisms of Endothelin Receptor Type-A Gene could Affect the Psoriasis Area and Severity Index Score and Endothelin 1 Levels.

BACKGROUND: The etiopathogenesis of psoriasis has not been clearly elucidated although the role of chronic inflammation, imbalance between pro- and anti-inflammatory cytokines, and many immunological events have been established. Endothelin 1 (EDN1) and endothelin receptor type-A (EDNRA) are implicated in the inflammatory process. The relationships between EDN1 and EDNRA polymorphisms with several diseases have been found. AIMS AND OBJECTIVES: This study examined the possible association of EDN1 (G5665T and T-1370G) and EDNRA (G-231A and G + 70C) single nucleotide polymorphisms (SNPs) with the occurence of psoriasis, and evaluated the relationship between genotypes and clinical/laboratory manifestation of psoriasis. MATERIALS AND METHODS: We analyzed genotype and allele distributions of the above-mentioned polymorphisms in 151 patients with psoriasis and 152 healthy controls by real-time PCR combined with melting curve analysis. RESULTS: We did not find significant differences in the genotype and allele distributions of EDN1 T-1370G, EDNRA G-231A, and EDNRA G+70C polymorphisms between patients with psoriasis and healthy controls. Psoriasis area and severity index (PASI) score of EDNRA -231 polymorphic A allele carrying subjects (AA and AA + AG) was higher than that of wild homozygotes (P = 0.044 and P = 0.027, respectively). In addition, EDN1 levels in EDNRA+70 polymorphic C allele carriers (CC + CG) were elevated when compared with GG genotype; however, the difference was at borderline significance (P = 0.05). CONCLUSION: Although there were no associations between studied polymorphisms and psoriasis susceptibility, the PASI score and EDN1 levels seem to be affected by EDNRA G-231A and G + 70C polymorphisms.

Muir-Torre syndrome: a case report and review of the literature.

Muir-Torre syndrome is a rare autosomal dominant genodermatosis characterized by the occurrence of sebaceous gland neoplasm associated with visceral malignancies. Most patients present with sebaceous adenomas, but cystic sebaceous neoplasms have been reported as specific markers of the syndrome. Gastrointestinal and genitourinary cancers are the most common internal malignancies. Colorectal cancer is the commonest visceral neoplasm in Muir-Torre syndrome patients. In this case report, we describe a rare case of Muir-Torre syndrome associated with colon cancer, and we demonstrate the important role of the dermatopathologist in alerting the clinician to the possibility of Muir-Torre syndrome when the diagnosis of sebaceous neoplasm is made.

Photoletter to the editor: Cutaneous myxoid fibroblastoma.

Cutaneous myxoid fibroblastoma is an extremely rare soft tissue tumor, diagnosed based on histopathology. The histopathological triad for the diagnosis of the disease includes 1) spindle-shaped and/or stellate cells with elongated nuclei and eosinophilic cytoplasm 2) distribution of cell in amyxoid stroma containing very fewcollagen fibers 3) cellular atypiawithout marked nuclear polymorphism in some cells. To date, only single cases of this disease have been reported. We report a new case and discuss the disease.

Azathioprine-induced liver injury in a patient with multiple autoimmune syndrome.

Extraintestinal manifestations are frequent in patients with ulcerative colitis. They are most commonly associated with active bowel disease but can also occur prior to bowel disease or during a period of remission. The disease often requires long-term therapy. The tolerability of drugs is essential for the comprehensive management of patients. Azathioprine is considered an indispensable drug for the treatment of severe ulcerative colitis patients. It is used to prevent relapse or to treat patients who are refractory to corticosteroids. We report a patient who had alopecia areata, vitiligo, recurrent episcleritis, ulcerative colitis and azathioprine-induced liver injury, and review the related literature.