RESUMO
BACKGROUND: Basosquamous cell carcinoma (BSCC) is a poorly known tumor showing pathological features of both basal and squamous cell carcinomas. BSCC has never been specifically studied in organ transplant recipients (OTRs). OBJECTIVE: We sought to study the clinicopathologic features of BSCC in OTRs and compare them with BSCC from nongrafted patients. METHODS: Tumors diagnosed as BSCC were re-evaluated pathologically and immunohistochemically for the expression of the human epithelial antigen to confirm the diagnosis. The clinicopathologic features of BSCC in OTRs were compared with 30 BSCC obtained from nongrafted patients. RESULTS: In our cohort of 3520 OTRs, 12 patients (0.34%) developed BSCC after a mean postgraft delay of 13.2 years, ie, later than other skin carcinomas. As compared with control patients, the age of OTRs with BSCC and the tumor thickness were significantly lower. BSCC were located on the head/neck in both groups in more than 75% of cases. No metastases developed in OTRs (mean follow-up 2.8 years). During the follow-up period (mean 16 years), OTRs with BSCC developed up to 220 additional premalignant and malignant skin tumors. After the diagnosis of BSCC, two patients developed lymph node metastasis of distinct squamous cell carcinoma. LIMITATIONS: This is a single-center, retrospective study. CONCLUSIONS: BSCC is a rare tumor, even in OTRs who are at high risk of carcinomas. Its incidence (0.34%) is comparable with that of cutaneous lymphomas and melanomas, and much lower than that of other nonmelanoma skin cancers. Contrary to previous reports, BSCC do not seem to behave more aggressively than other nonmelanoma skin cancers.
Assuntos
Carcinoma Basoescamoso/epidemiologia , Carcinoma Basoescamoso/patologia , Transplante de Órgãos/estatística & dados numéricos , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Carcinoma Basoescamoso/terapia , Estudos de Casos e Controles , Comorbidade , Feminino , França/epidemiologia , Humanos , Imuno-Histoquímica , Incidência , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Transplante de Órgãos/efeitos adversos , Prognóstico , Doenças Raras , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Distribuição por Sexo , Neoplasias Cutâneas/terapia , Taxa de SobrevidaRESUMO
Acne can have an important psychological impact. We surveyed 852 adolescents aged 12-25 years about their knowledge of acne and its treatment in a non-medical context. The study involved a questionnaire administered to callers to a youth telephone helpline in France. Callers were categorized into those who currently had acne, those who had had acne previously, and those who had never had acne. Most respondents (66.2%) had experienced acne symptoms, which were mild in 50.2% of cases and severe in 16% of cases. Often, acne had been long-lasting (>12 months in 49.6% of cases). Many thought that gender, excess weight, eating dairy products, and physical activity did not influence acne, and that frequent washing could improve acne. Eating chocolate and snacks, smoking cigarettes, sweating, not washing, touching/squeezing spots, eating fatty foods, using make-up, pollution, and menstruation were thought to worsen acne. The majority (80.8%) did not believe acne to be a disease, but rather a normal phase of adolescence, yet 69.3% agreed it should be treated. There was a preference for topical vs. systemic treatment. Many (38.6%) of the respondents with acne had not consulted a physician. Almost two-thirds of respondents wanted more information about acne. Providing more information about acne might increase the likelihood of them consulting a physician and getting better treatment for the condition.
Assuntos
Acne Vulgar/psicologia , Comportamento do Adolescente , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Acne Vulgar/diagnóstico , Acne Vulgar/terapia , Adolescente , Adulto , Criança , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Educação de Pacientes como Assunto , Percepção , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença , Inquéritos e Questionários , Adulto JovemRESUMO
Basal cell carcinoma (BCC), the most common human cancer, is seldom seen in the genital area. We present a case of an extensive pigmented BCC that developed on the mucosal surface of the vulva of an elderly woman and briefly review the relevant literature on vulvar BCC.
Assuntos
Carcinoma Basocelular/diagnóstico , Prurido/etiologia , Neoplasias Vulvares/diagnóstico , Idoso de 80 Anos ou mais , Carcinoma Basocelular/patologia , Feminino , Humanos , Neoplasias Vulvares/patologiaRESUMO
The Issenheim altar by Mathias Grünenwald (Unterlinden museum in Colmar) shows various scenes from the life of St Antony, abbot. The Tentation panel has been considered as an illustration of the sacer ignis, or St Antony's disease (ergotism). In fact, it may more likely indicate an early representation of Syphilis, or the French disease, as discussed here.
Assuntos
Ergotismo/história , Pinturas/história , Catolicismo , França , História do Século XVIRESUMO
BACKGROUND: Immunosuppression favors the development of skin cancer. Experimental data suggest that sirolimus (SRL) has antitumoral and antiangiogenic properties. An investigation was undertaken into the effects of SRL on squamous cell carcinoma (SCC) developing in organ transplant recipients (OTR) receiving immunosuppressive treatments, with special emphasis on vascularization. MATERIALS AND METHODS: SCC that developed in eight OTR before and after conversion from calcineurin inhibitors (CNI) to SRL were compared for thickness, differentiation, ulceration, perineural invasion, density of peritumoral infiltrate, peritumoral vascularization, density of T-regulatory cells and of intratumoral Langerhans cells and growth fraction. RESULTS: SCC developing under SRL showed lower peritumoral vascularization and thickness, and higher growth fraction and density of peritumoral T-regulatory cells. CONCLUSION: Conversion from CNI to SRL at clinically relevant doses is associated in vivo with a reduced vascularization and thickness of post-transplant human cutaneous SCC. This effect could account for the beneficial effect of SRL on immunosuppression-induced skin carcinogenesis in humans.
Assuntos
Inibidores de Calcineurina , Carcinoma de Células Escamosas/irrigação sanguínea , Neovascularização Patológica/tratamento farmacológico , Complicações Pós-Operatórias , Sirolimo/administração & dosagem , Neoplasias Cutâneas/irrigação sanguínea , Adulto , Idoso , Inibidores da Angiogênese/administração & dosagem , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/patologia , Estudos de Coortes , Ciclosporina/administração & dosagem , Feminino , Rejeição de Enxerto/tratamento farmacológico , Transplante de Coração , Humanos , Técnicas Imunoenzimáticas , Imunossupressores/administração & dosagem , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/patologia , Resultado do TratamentoRESUMO
Porokeratoma (porokeratotic acanthoma) is a very recently described tumor-like acanthoma with features of porokeratosis (cornoid lamellation). We report herein a new case of this poorly known lesion that was studied immunohistochemically and discuss briefly its relationship with porokeratosis.
Assuntos
Acantoma/patologia , Poroceratose/patologia , Pele/patologia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Acne is a disorder in which adherence has a major impact on treatment outcome. OBJECTIVE: To create an easy-to-use tool to assess treatment adherence, based on a questionnaire that can be used on a daily basis by dermatologists. METHODS: First, we evaluated adherence by comparing responses to a self-administered questionnaire with the dermatologist's prescription. Second, concordance was assessed between adherence and each question of a dermatologist-directed questionnaire (DDQ) administered during the consultation. Third, DDQ questions were combined to construct a mini-questionnaire, and these combinations were tested to maximize specificity. RESULTS: The study included 246 patients, who were prescribed topical treatment alone, combined treatment (excluding oral isotretinoin) or oral isotretinoin alone. The mini-questionnaires for oral and topical treatments had 89% specificity for detecting poor adherence. An inappropriate answer to one question classified the patient as a probable poor compliance. CONCLUSIONS: Our mini-questionnaires provide dermatologists with specific tools to rapidly identify poor compliance.
Assuntos
Acne Vulgar/tratamento farmacológico , Fármacos Dermatológicos/administração & dosagem , Isotretinoína/administração & dosagem , Adesão à Medicação , Inquéritos e Questionários/normas , Administração Cutânea , Adolescente , Adulto , Feminino , Humanos , Masculino , Prescrições , Qualidade de Vida , Resultado do TratamentoRESUMO
Existing scoring systems for facial acne focus on the lesions themselves, but clinical decisions are based on a general assessment of severity, including the time since onset, the site(s) of involvement, the patient's history, and the response to prior treatments. The aim of this study was to investigate the influence of some of these factors on the global assessment of acne severity. Involvement of the trunk, prior systemic treatment and a positive family history of acne increased the severity score. Inclusion of these factors could help to compose more homogeneous groups for clinical trials.
Assuntos
Acne Vulgar/epidemiologia , Humanos , Prognóstico , Índice de Gravidade de DoençaRESUMO
Multinucleate cell angiohistiocytoma (MCA) is a rare benign vascular proliferation of the skin of unknown cause. About 75 cases have been reported previously. We present herein three new cases of MCA studied immunohistologically and present a review the relevant literature that delineates the salient clinicopathological features of this unusual entity.
Assuntos
Núcleo Celular/patologia , Histiocitoma Fibroso Benigno/patologia , Neoplasias Cutâneas/patologia , Idoso , Biópsia por Agulha , Feminino , Hemangioma/patologia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de RiscoRESUMO
Granular parakeratosis is a rare benign dermatosis caused by an acquired disorder of keratinization that usually manifests with reddish-brown keratotic papules and plaques in intertriginous areas. It has specific histologic features but its pathogenesis remains unclear. Its frequency is probably underestimated because the condition is usually misdiagnosed as simple intertrigo. We report herein a new case of granular parakeratosis in a woman treated with liposomal doxorubicin for ovarian carcinoma that showed complete remission after discontinuation of chemotherapy. The relationship between granular parakeratosis and chemotherapy is discussed.
Assuntos
Antibióticos Antineoplásicos/efeitos adversos , Doxorrubicina/análogos & derivados , Neoplasias Ovarianas/tratamento farmacológico , Paraceratose/induzido quimicamente , Polietilenoglicóis/efeitos adversos , Doxorrubicina/efeitos adversos , Epiderme/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Paraceratose/patologiaRESUMO
BACKGROUND: Acne can have important psychological repercussions. OBJECTIVES: We studied adolescents' perceptions of acne, in a nonmedical context. METHODS: Between November 2004 and January 2005, a questionnaire was presented to adolescents calling a youth helpline. It focused on perceptions of acne and, among callers with personal experience of acne, its severity and treatment. Callers were divided into those with acne, those having had acne and those never having had acne. RESULTS: The questionnaire was completed by 1,566 callers. It showed that 51% of respondents with acne did not seek medical help; acne has as big a psychological impact as some far severer diseases; many respondents with no history of acne said they were very worried that they would develop this skin disorder. CONCLUSIONS: This study underlines the major psychological impact of acne. Young people need to be informed that acne can be treated.
Assuntos
Acne Vulgar/psicologia , Atitude Frente a Saúde , Qualidade de Vida , Acne Vulgar/epidemiologia , Acne Vulgar/patologia , Adolescente , Adulto , Criança , Feminino , Seguimentos , França/epidemiologia , Humanos , Masculino , Visita a Consultório Médico/estatística & dados numéricos , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença , Distribuição por Sexo , Inquéritos e QuestionáriosRESUMO
Discoidin domain receptor 1 (DDR1) is a receptor tyrosine kinase activated by collagen. DDR1 is constitutively expressed in a variety of normal and transformed epithelial cells and plays a role in cell migration and differentiation through as yet unidentified signaling pathways. We previously reported inducible expression of DDR1 in human leukocytes and suggested a role for the DDR1a isoform in leukocyte migration through extracellular matrix. Here, we evaluated the contribution of DDR1 in the differentiation of the human monocytic THP-1 cells overexpressing these isoforms and of primary macrophages. Interestingly, collagen activation of DDR1b, but not DDR1a, further promoted phorbol ester-induced differentiation of THP-1 cells as determined by reduced cell proliferation and up-regulated expression of HLA-DR, CD11c, CD14, and CD40. Collagen activation of DDR1b also induced the recruitment and phosphorylation of Shc and subsequent phosphorylation of p38 mitogen-activated protein (MAP) kinase and its substrate ATF2. A p38 MAP kinase inhibitor, SB203580, completely inhibited DDR1b-mediated HLA-DR expression. Activation of DDR1 endogenously expressed on macrophages also up-regulated their HLA-DR expression in a p38 MAP kinase-dependent manner. Thus, DDR1b in response to collagen transduces signals that promote maturation/differentiation of HLA-DR-positive antigen-presenting cells and contributes to the development of adaptive immunity in a tissue microenvironment.
Assuntos
Proteínas Adaptadoras de Transdução de Sinal , Proteínas Adaptadoras de Transporte Vesicular , Colágeno/metabolismo , Macrófagos/enzimologia , Proteínas Quinases Ativadas por Mitógeno/metabolismo , Receptores Proteína Tirosina Quinases/metabolismo , Receptores Mitogênicos/metabolismo , Diferenciação Celular , Linhagem Celular Transformada , Receptores com Domínio Discoidina , Ativação Enzimática , Fator Estimulador de Colônias de Granulócitos e Macrófagos/farmacologia , Antígenos HLA-DR/metabolismo , Humanos , Sistema de Sinalização das MAP Quinases , Macrófagos/efeitos dos fármacos , Macrófagos/imunologia , Monócitos/imunologia , Fosforilação , Isoformas de Proteínas/metabolismo , Proteínas/metabolismo , Proteínas Adaptadoras da Sinalização Shc , Proteína 1 de Transformação que Contém Domínio 2 de Homologia de Src , Acetato de Tetradecanoilforbol/farmacologia , Proteínas Quinases p38 Ativadas por MitógenoRESUMO
CDK9 is the kinase subunit of positive transcription elongation factor b (P-TEFb) that enables RNA polymerase (Pol) II's transition from promoter-proximal pausing to productive elongation. Although considerable interest exists in CDK9 as a therapeutic target, little progress has been made due to lack of highly selective inhibitors. Here, we describe the development of i-CDK9 as such an inhibitor that potently suppresses CDK9 phosphorylation of substrates and causes genome-wide Pol II pausing. While most genes experience reduced expression, MYC and other primary response genes increase expression upon sustained i-CDK9 treatment. Essential for this increase, the bromodomain protein BRD4 captures P-TEFb from 7SK snRNP to deliver to target genes and also enhances CDK9's activity and resistance to inhibition. Because the i-CDK9-induced MYC expression and binding to P-TEFb compensate for P-TEFb's loss of activity, only simultaneously inhibiting CDK9 and MYC/BRD4 can efficiently induce growth arrest and apoptosis of cancer cells, suggesting the potential of a combinatorial treatment strategy.
Assuntos
Quinase 9 Dependente de Ciclina/metabolismo , Regulação da Expressão Gênica , Proteínas Nucleares/metabolismo , Proteínas Proto-Oncogênicas c-myc/metabolismo , Fatores de Transcrição/metabolismo , Proteínas de Ciclo Celular , Quinase 9 Dependente de Ciclina/antagonistas & inibidores , Humanos , Fator B de Elongação Transcricional Positiva/metabolismoRESUMO
Acne is the most frequent reason for seeing a dermatologist, but its physiopathology is not completely well-known. Yet understanding of the mechanisms of action of the different acne treatments is very important to optimize their use. A lot of new data on the physiopathology have recently been published in the acne field. This paper summarizes the main points of these new facts.
Assuntos
Acne Vulgar/tratamento farmacológico , Acne Vulgar/fisiopatologia , Antibacterianos/uso terapêutico , Ceratolíticos/uso terapêutico , Retinoides/uso terapêutico , Glândulas Sebáceas/metabolismo , Acne Vulgar/imunologia , Administração Oral , Administração Tópica , Fármacos Dermatológicos/uso terapêutico , Feminino , Seguimentos , Humanos , Masculino , Fatores de Risco , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Androgens stimulate sebum production which is necessary for the development of acne. Acne in women may thus be considered as a manifestation of cutaneous androgenization. Most of acnes may be related to an idiopathic skin hyperandrogenism due to in situ enzyme activity and androgen receptor hypersensitivity, as also noted in idiopathic hirsutism. Some acne may correspond to elevated ovarian or adrenal androgen secretion. The presence of acne in women may lead to a diagnosis of functional hyperandrogenism, either polycysticovary syndrome or nonclassical 21-hydroxylase deficiency. Plasma level assays for testosterone, delta 4 androstenedione and 17-OH progesterone and ovarian echography are necessary to determine the possibility for an ovarian or adrenal hyperandrogenism, but not to better treat acne. The goal of hormonal therapy in acne is to oppose the effects of androgens on the sebaceous gland. Hormones may be used in female acne in the absence of endocrine abnormalities. Antiandrogens (cyproterone acetate or aldactone) may be useful in severe acne, hormonal contraceptives with cyproterone acetate or non androgenic progestins in mild or common acne often in association with other anti-acneic drugs. Glucocorticoids have to be administered in acne fulminans and other forms of acute, severe, inflammatory acne, for their anti-inflammatory properties.
Assuntos
Acne Vulgar/fisiopatologia , Androgênios/efeitos adversos , Acne Vulgar/tratamento farmacológico , Antagonistas de Androgênios/farmacologia , Antagonistas de Androgênios/uso terapêutico , Androgênios/farmacologia , Feminino , Glucocorticoides/farmacologia , Glucocorticoides/uso terapêutico , Humanos , Hipersensibilidade , Masculino , Receptores Androgênicos/fisiologia , Glândulas Sebáceas/efeitos dos fármacos , Glândulas Sebáceas/fisiologia , Fatores SexuaisRESUMO
Data on post-graft cutaneous cryptococcosis (CC) are rare. The objective was to delineate the epidemiological, clinical, diagnostic, therapeutic features of CC in organ transplant recipients. We compared cases from a cohort of 3,670 transplanted adults with cases from a regional cryptococcosis registry including 122 patients. Four CC were diagnosed in the transplanted cohort (1) corresponding in the regional registry to 33% of the 12 cases of cryptococcosis after transplantation, while among the 110 non-grafted patients, only five cryptococcosis were cutaneous (4%). CC appeared as a single (3 patients) ulcer or nodule over 1cm in size in an uncovered body zone, on average 13 months post-graft. 3 patients had concomitant opportunistic infections or a recent increase in their immunosuppression. All CC after transplantation were localized exclusively to the skin, raising the question of the mode of contamination (through the skin or the lungs). Evidence of dissemination is difficult because of the poor sensitivity of diagnostic tests. Fluconazole was the treatment of choice in association with immunosuppressive treatment tapering.
Assuntos
Criptococose/diagnóstico , Criptococose/imunologia , Dermatomicoses/diagnóstico , Dermatomicoses/imunologia , Imunossupressores/efeitos adversos , Transplante de Órgãos/efeitos adversos , Adulto , Idoso , Antifúngicos/uso terapêutico , Criptococose/tratamento farmacológico , Criptococose/epidemiologia , Dermatomicoses/tratamento farmacológico , Dermatomicoses/epidemiologia , Feminino , Fluconazol/uso terapêutico , Humanos , Imunossupressores/administração & dosagem , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos RetrospectivosRESUMO
Epidermal growth cell receptors (EGFR) play a key role in tumor proliferation. Their inhibitors (anti-EGFR) are promising treatments for various types of cancers. Papulopustular follicular eruptions are the most frequent dermatological side effect and occur in 45 to 85% of patients receiving this treatment. Paronychias appear after several weeks of treatment. They are painful and impair hand and foot function. A positive correlation seems to exist between the intensity of the papulo-follicular eruption, tumor regression and survival.