Lupus panniculitis: a rare bilateral and symmetrical manifestation of cutaneous lupus erythematosus in an adolescent girl.

Lupus panniculitis is included in the chronic cutaneous lupus erythematosus group. An 18-year-old female patient came with the complaint of lumps on her face. When she was 16 years old, the patient started to complain about lumps on her right lower arm. Lumps were observed on her left cheek and right chin during the ongoing treatment. Histopathology results showed lymphocyte infiltration in between lobular adipocyte with fibrotic and fat necrosis in the subcutis. Lupus panniculitis lesions in this patient were found both on her face and on her lower arms, which are not considered common predilection sites of lupus panniculitis. The skin lesion observed in this patient was also bilateral and symmetrical, which was a rare finding.

Increased expression of versican in the inflammatory response to UVB- and reactive oxygen species-induced skin tumorigenesis.

Excessive exposure to UV radiation is a major risk factor for developing skin cancer. UV-induced reactive oxygen species (ROS) cause accumulation of DNA damage products such as 8-oxoguanine (8-oxoG) in the skin. We have previously shown that mice lacking the repair enzyme 8-oxoguanine glycosylase (Ogg1 knockout mice) are highly susceptible to skin cancer after long-term UVB exposure. To investigate the genes involved, we performed gene profiling of Ogg1 knockout mouse skin after UVB exposure. Among the up-regulated genes in UVB-treated Ogg1 knockout mice, inflammatory response pathway-related genes were most affected. The Vcan gene, which encodes the large extracellular matrix proteoglycan versican, was continuously up-regulated in UVB-treated Ogg1 knockout mice, suggesting that versican is a mediator of skin cancer development. We examined the expression pattern of versican in skin tumors from wild-type mice and UVB-treated Ogg1 knockout mice, and also analyzed 157 sun-related human skin tumors. Versican was strongly expressed in malignant skin tumors in both mice and humans, and especially in Ogg1 knockout mice. Additionally, infiltrating neutrophils strongly colocalized with versican in UVB-treated Ogg1 knockout mouse skin. These data demonstrate that inflammatory responses, particularly neutrophil infiltration and versican up-regulation, are closely involved in UVB/ROS-induced skin tumorigenesis.

Skin tumours induced by narrowband UVB have higher frequency of p53 mutations than tumours induced by broadband UVB independent of Ogg1 genotype.

Different wavelengths of ultraviolet (UV) light have different promoting effects on skin carcinogenesis. Narrowband UVB (NB-UVB) has a single-peak wavelength of 311 nm and is widely used for treating skin diseases. Our previous work showed that, in comparison with conventional broadband UVB (BB-UVB), long-term exposure to NB-UVB induces higher frequency of skin cancer in mice, and it suggested that this is mediated through the formation of cyclobutane pyrimidine dimers (CPDs). To explore whether the frequency of p53 mutations in skin tumours correlates with CPD-induced mutations, we compared the frequency and types of p53 mutations between NB-UVB-induced and BB-UVB-induced malignant skin tumours produced in wild-type and Ogg1 knockout mice, which are deficient in repair of oxidative 8-oxoguanine (8-oxoG), a DNA damage mediated by reactive oxygen species (ROS). The frequency of p53 mutation was significantly higher in NB-UVB-induced than in BB-UVB-induced tumours in both wild-type and Ogg1 knockout mice. Most of the p53 mutations found were G:C → A:T transitions at dipyrimidine sites in both the NB-UVB- and BB-UVB-exposed groups. However, G:C → T:A mutations caused by 8-oxoG did not increase in Ogg1 knockout mice exposed to either NB-UVB or BB-UVB. Our results strongly suggest that NB-UVB induces highly malignant tumours caused by p53 dipyrimidine mutations through the formation of CPDs.

Case of lichen planus with unusual features.

A 25-year-old woman came with an itchy red rash on her back since 2 years ago. This lesion then extended to the abdomen, arms and legs. From the patient's back, we found irregular linear hyperpigmented patches with some of the edges in the form of hyperpigmented plaques. On the abdomen, arms and legs, erythema-hyperpigmented plaque and patches were visible along the elevated edges with multiple scattered sizes. Lichen planus (LP) has several types based on various clinical manifestations. The diagnosis of LP can be made based on the clinical appearance and symptoms of pruritus. Many diseases can mimic other diseases so histopathology is used to make the diagnosis. Here, we report a case of LP with unusual features with diagnosis confirmed by histopathological examination. The patient was treated with oral and topical potent corticosteroids with good response.

Impact of pandemic COVID-19 on dermatology and venereology outpatient clinic in a tertiary referral hospital in Yogyakarta, Indonesia.

COVID-19 has spread throughout the world rapidly, including in Indonesia. During this pandemic, there are differences in the number and types of patient cases who attend the dermatology and venereology outpatient clinic. This study aimed to investigate the differences in the number of cases, disease profiles, diagnostic procedures, and therapy procedures before and during the COVID-19 pandemic in the dermatology and venereology outpatient clinic in Dr. Sardjito General Hospital, Yogyakarta, Indonesia. At the beginning of the COVID-19 pandemic, there was a 61.2% decrease in patients visiting outpatient clinic compared to the same period in previous year. There was also a decrease in the number of diagnostic procedures and therapeutic procedures performed in the outpatient clinic. For the disease profile of the total number of patients who visited the outpatient clinic, there was a slight difference. In 2019, the number of cases of acne vulgaris became the second largest, but in 2020, the number of cases of acne vulgaris decreased to the fifth largest. These results support the finding that COVID-19, although not a skin disease, has an impact on dermatology and venereology outpatient clinic.

Inhibitory effects of dietary Spirulina platensis on UVB-induced skin inflammatory responses and carcinogenesis.

Reactive oxygen species produced in response to UVR are important in skin tumor development. We have previously reported that deficiency of the Ogg1 gene, encoding the repair enzyme for 8-oxo-7,8-dihydroguanine (8-oxoG), increases skin tumor incidence in mice upon repetitive UVB exposure and modulation of UVB-induced inflammatory response. Spirulina platensis is used as a human food supplement because it contains abundant nutritional and antioxidant components. Therefore, we investigated the inhibitory effects of S. platensis on UVB-induced skin tumor development in Ogg1 knockout-(KO) mice and the wild-type (WT) counterpart. Dietary S. platensis suppressed tumor induction and development in both genotypes compared with our previous data without S. platensis. Induction of erythema and ear swelling, one of the hallmarks of UVB-induced inflammatory responses, was suppressed in the skin of Ogg1-KO mice and albino hairless mice fed with dietary S. platensis. Compared with untreated mice, S. platensis-administered mice showed significantly reduced 8-oxoG formation in the skin after UVB exposure. Moreover, we found that S. platensis effectively downregulated the signal proteins p38 mitogen-activated protein kinase, stress-activated protein kinase/c-Jun N-terminal kinase, and extracellular signal-regulated kinase after UVB exposure especially in Ogg1-KO mice. Our results suggest that S. platensis exerts antitumor effects against UVB irradiation in the skin through its anti-inflammatory and antioxidant effects.

Hydrochlorothiazide enhances UVA-induced DNA damage.

The UVA is currently thought to be carcinogenic because, similar to UVB, it induces the formation of cyclobutane pyrimidine dimers (CPDs). Various drugs have been reported to cause photosensitive drug eruptions as an adverse effect. Although the precise mechanism of photosensitive drug eruption remains to be elucidated, it is generally accepted that free radicals and other reactive molecules generated via UV-irradiated drugs play important roles in the pathogenesis of photosensitive drug eruptions. The waveband of concern for photo-reactive drugs is UVA-visible light, but some extend into the UVB region. We tested whether photosensitive drugs could enhance CPD formation after UVA exposure by using isolated DNA in the presence of several reported photosensitive drugs using high-performance liquid chromatography. We found that the diuretic agent hydrochlorothiazide (HCT) significantly enhanced the production of TT dimers over a wide range of UVA. Furthermore, we investigated whether UVA plus HCT could enhance CPD production in xeroderma pigmentosum model mice defective in nucleotide excision repair. Immunofluorescence studies showed that CPD formation in the skin significantly increased after 365 nm narrow-band UVA irradiation in the presence of HCT, compared with that in wild-type mice. HCT could be used with caution because of its enhancement of UVA-induced DNA damage.