Chronic Skin Lesions Research Articles

A 49-year-old woman with chronic skin lesions, acute mental status changes and new pulmonary infiltrate: case discussion from the University of Louisville Hospital.

A 49-year-old woman with chronic skin lesions, acute mental status changes and new pulmonary infiltrate: case discussion from the University of Louisville Hospital.

Pink papule on the temple

Bowen’s disease (BD) is a relatively rare squamous cell carcinoma in situ. Contributing factors are solar exposure, ionizing radiations, arsenic, Human Papilloma Virus (HPV) infection, some genodermatoses. It can be a result of chronic skin lesions including actinic keratoses or discoid lupus. No cases of the Bowen’s disease involving the temporal biopsy site have been reported in the literature. We report the case of a 72-year old patient, with skin phototype IIIa, on treatment for Giant Cell Arteritis (Horton disease) for 1 year, receiving oral corticosteroid therapy and antiplatelet agents, with a 6-month history of asymptomatic papule involving the temporal biopsy site, gradually increasing in size. Dermatological assessment showed pink-yellow uninfiltrated papule measuring 0.5 cm in diameter, with a slightly keratotic surface on right temple involving the temporal biopsy site. The patient underwent complete biopsy resection which showed parakeratotic, acanthosic epidermal surface showing architectural disorganization associated with marked cytonuclear atypies and mitoses. Underlying dermis showed moderate, perivascular inflammatory infiltrate suggesting BD. The patient underwent liquid nitrogen cryotherapy and received 5-fluorouracil cream for 1 month associated with photoprotection. BD is usually associated with a favorable prognosis. On the other hand, in the absence of diagnosis and appropriate treatment it can lead to invasive squamous cell carcinoma.

Criação e uso de banco de dados fotográfico para acompanhamento de pacientes com lesões dermatológicas crônicas decorrentes da hanseníase

Introduction: The Prevention and Wound Care Center was established in 2003 in order to assist the hospital and the local demand of patients who had leprosy and present or presented some kind of dermatological ulceration. The photographic record database is an important tool for monitoring the evolution of the wound, which aims to document the state of the wound before and after procedures or the use of dressings curatives, as a data source on the care provided to the chronic wound carrier as well as an object of teaching and research. Objectives: To create a database of photographic records of patient injuries of evolving character, so that such injuries can be assessed with the passing of time and according to the treatment. Results: A database containing photographic records of the patients was created and organized in folders and subfolders in a simple manner with ease of access and understanding. Conclusion: The photographic record in the database substantially improves monitoring and treatment of patients with chronic skin lesions.

Hematologic and Biochemical Values of Wild Red-Tailed Amazon Parrot (Amazona brasiliensis) Nestlings With Abnormal Clinical Examination in Rasa Island, Brazil

The red-tailed Amazon parrot (Amazona brasiliensis) is an endangered psittacine species, but little information is available about abnormal clinical findings and hematologic and biochemical values of this species, which are important for monitoring the health of this population. To determine hematologic and biochemical values for wild red-tailed parrot nestlings exhibiting abnormal clinical findings, 31 nestlings from the Rasa Island (Paraná State, Southern Brazil) were physically restrained for clinical examination and blood sample collection. On physical examination, 26 birds had mild abnormalities and 5 had severe disorders. Parrots were divided into 5 groups according to the following clinical findings: presence of ectoparasites (group 1), respiratory disorders (group 2), chronic skin lesions caused by fly larvae (group 3), beak disorders (group 4), and severe clinical signs (group 5). Abnormal hematologic and biochemical findings in the nestlings were high total protein in group 3; low values for hemoglobin and mean corpuscular hemoglobin concentration in group 4; low glucose concentration, high mean absolute heterophil count, and high heterophil : lymphocyte ratio in group 5; high concentrations of total plasma protein in groups 3 and 4; and high globulin concentration in groups 3 and 5. In general, the population assessed was in good condition. These results provide a guide to the expected clinical findings associated with hematologic and biochemical concentrations in a population of free-living parrots with abnormal clinical examination findings. The data support the conservation planning and health monitoring of the endangered red-tailed Amazon parrot.

Respiratory Manifestations of Food Allergy in Babies with Atopic Dermatitis: A Prospective Study in 395 Children

Background. Scientific evidence accumulated in recent years indicates that food and in ha l ant allergens can trigger atopic dermatitis (AD). It may be hypothesized that, also in AD, the allergens could induce a cutane ous hyper reactivity analogous to the bronchial hyperreactivity (BHR) described in al ler gic pa tients with asthma. Nonspecific stimuli can therefore trigger and wors en the skin lesions. Eosinophils, as in asthma, seem to play an impor tant role in in ducing and maintaining the skin lesions. Objective. Taken to gether, these data suggest that in AD there exists a vicious circle, by which immunologic and nonim munologic factors act in various ways and at differ ent levels triggering dif ferent, though synergistic, reactions to initiate, am plify and maintain the chronic skin lesions characteristic of the condi tion. Patients and Methods. We have pros pectively 395 atopic children attend ing our Di vision because they were affected with AD, and found 213/395 babies af fected contemporane ously with AD and respiratory allergy. The di agnosis of atopic diseases in the children was done according to family and clinical his tory, physical examination and positive SPTs and/or RAST to the most com mon inhalant and/or food allergens Results. Of them 14 babies experienced a positive OFC (open chal lenge test) to different foods (9 cow milk CM, 5 hydrolysate formulas, HFs, and one fish, but we stress that three of them reacted to one drop or two ml of CM) Positivity of family history and elevated total IgE confirm that AD is a ge netic disease. Conclusion. The data confirms the studies that have suggest ed that al ler gens in turn could elicit respiratory symptoms, that can be dist in gu ished as food induced asthma and asthma with food allergy (FA). In sum mary, FA pro vokes wheezing in a small, but significant number of chil dren suffering from AD and asthma, thus con fronting pediatri cians with one of the most de mand ing chal len ges

Pythiosis cutánea en equinos tratados con acetonida de triamcinolona. Parte 1. Caracterización clínica

RESUMENObjetivo. El objetivo del estudio fue caracterizar clínicamente el proceso de cicatrización de la pythiosis cutánea en equinos tratados con acetonida de triamcinolona. Materiales y métodos. Se realizó un estudio descriptivo, no probabilístico, de conveniencia. Fueron utilizados 24 equinos con pythiosis cutánea. A un grupo le fue aplicado 50 mg de acetonida de triamcinolona vía intramuscular (GT) y al otro grupo no fue aplicado tratamiento (GC). Se realizó caracterización clínica y macroscópica de la lesión cada 4 días hasta la recuperación completa del granuloma en el GT. Siendo verificada la disminución del exudado fibrinosanguinolento, prurito, presencia de trayectos fistulosos y salida de kunkers, también, fueron realizadas proyecciones radiológicas para evaluar el grado de compromiso óseo y fibrosis tecidual. Resultados. Macroscópicamente, los animales del GT presentaron diminución progresiva en las características clínicas de la enfermedad a los 16±1,4 días post aplicación del tratamiento. La contracción de la herida fue del 100% a los 60±3.4 días post aplicación del tratamiento en todos los granulomas del GT, siendo altamente significativa (p<0.0001). Radiológicamente, se encontró invasión a los tejidos subyacentes comprometiendo estructuras óseas, caracterizándose por fibrosis tisular, exostosis moderada, osteólisis y osteomielitis. Los animales del GC no presentaron mejoría en las características clínicas y macroscópicas de la pythiosis y se mantuvieron iguales durante todo el estudio. Conclusiones. La acetonida de triamcinolona es una buena alternativa terapéutica en el tratamiento de las heridas granulomatosas de pythiosis en equinos con 100% de recuperación clínica.

Glucagonoma Syndrome: A Case Report

A 58-year-old Malay female with underlying diabetes mellitus, presented with chronic skin lesions, associated with weight loss and anemia. There were erosive, scaling skin lesions over the extremities, gluteal region and perioral area. Skin biopsy histopathological examination revealed Necrolytic Migratory Erythema (NME). A CT scan of the abdomen revealed a pancreatic neck and body tumor with possible liver metastases. She was successfully treated with subcutaneous somatostatin and underwent distal pancreatectomy with wedge resection of liver nodule.

Atrophosclerodermic Manifestations of Lyme Borreliosis

This review summarizes the literature on scleratrophic skin lesions as a manifestation of aBorreliainfection. An association of morphea with Lyme borreliosis was mainly reported from Middle-European Countries, Japan and South America.B. afzeliihas been identified predominantly from the chronic skin lesions of acrodermatitis chronica atrophicans (ACA) and has been cultivated from morphea lesions in isolated cases. Scleratrophic skin lesions like morphea, lichen sclerosus et atrophicus (LSA) and anetoderma have been observed in coexistence with ACA. Since all these diseases show clinical and histological similarities, they might have a common origin. The laboratory results that point to a borrelial origin of these diseases, however, are contradictory. Antibodies againstB. burgdorferiwere detected in up to 50% of patients.BorreliaDNA was shown in up to 33% of morphea and 50% of LSA patients.Borreliawere visualized on histological slides by polyclonal antibodies in up to 69% of morphea and 63% of LSA patients. In other reports no evidence ofBorrelia– associated morphea or LSA has been reported. For anetoderma, single case reports showed positiveBorreliaserology and/or PCR and a response to antibiotic treatment. The response of scleratrophic skin lesions to antibiotic treatment varies and can be seen in patients with or without a proven association to aBorreliainfection. This suggests that scleratrophic diseases might be of heterogeneous origin, but aBorreliainfection could be one cause of these dermatoses.

Effects of Narrow-band IR-A and of Water-Filtered Infrared A on Fibroblasts.

Exposures of the skin with electromagnetic radiation of wavelengths between 670 nm and 1400 nm are often used as a general treatment to improve wound healing and reduce pain, for example, in chronic diabetic skin lesions. We investigated the effects of water-filtered infrared A (wIRA) and of narrow-band IR-A provided by a light-emitting diode LED (LED-IR-A) irradiation in vitro on 3T3 fibroblast cultures under defined conditions with and without glyoxal administration. Glyoxal triggers the formation of advanced glycation end products, thereby mimicking a diabetic metabolic state. Cell viability and apoptotic changes were determined by flow cytometry after vital staining with Annexin V, YO-PRO-1 and propidium iodide (PI), and by SubG1 assay. Mitochondrial function and oxidative stress were examined by vital staining for radical production, mitochondrial membrane potential (MMP) and the ratio of reduced-to-oxidized glutathione (GSH/GSSG). The metabolic state was monitored by a resazurin conversion assay. The numbers of apoptotic cells were reduced in cultures irradiated with wIRA or LED-IR-A. More mitochondria showed a well-polarized MMP after wIRA irradiation in glyoxal damaged cells. LED-IR-A treatment specifically restored the GSH/GSSG ratio. The immediate positive effects of wIRA and LED-IR-A observed in living cells, particularly on mitochondria, reflect the therapeutic benefits of wIRA and LED-IR-A.

Tissue Characterization after a New Disaggregation Method for Skin Micro-Grafts Generation

Several new methods have been developed in the field of biotechnology to obtain autologous cellular suspensions during surgery, in order to provide one step treatments for acute and chronic skin lesions. Moreover, the management of chronic but also acute wounds resulting from trauma, diabetes, infections and other causes, remains challenging. In this study we describe a new method to create autologous micro-grafts from cutaneous tissue of a single patient and their clinical application. Moreover, in vitro biological characterization of cutaneous tissue derived from skin, de-epidermized dermis (Ded) and dermis of multi-organ and/or multi-tissue donors was also performed. All tissues were disaggregated by this new protocol, allowing us to obtain viable micro-grafts. In particular, we reported that this innovative protocol is able to create bio-complexes composed by autologous micro-grafts and collagen sponges ready to be applied on skin lesions. The clinical application of autologous bio-complexes on a leg lesion was also reported, showing an improvement of both re-epitalization process and softness of the lesion. Additionally, our in vitro model showed that cell viability after mechanical disaggregation with this system is maintained over time for up to seven (7) days of culture. We also observed, by flow cytometry analysis, that the pool of cells obtained from disaggregation is composed of several cell types, including mesenchymal stem cells, that exert a key role in the processes of tissue regeneration and repair, for their high regenerative potential. Finally, we demonstrated in vitro that this procedure maintains the sterility of micro-grafts when cultured in Agar dishes. In summary, we conclude that this new regenerative approach can be a promising tool for clinicians to obtain in one step viable, sterile and ready to use micro-grafts that can be applied alone or in combination with most common biological scaffolds.

Tissue Characterization after a New Disaggregation Method for Skin Micro-Grafts Generation.

Several new methods have been developed in the field of biotechnology to obtain autologous cellular suspensions during surgery, in order to provide one step treatments for acute and chronic skin lesions. Moreover, the management of chronic but also acute wounds resulting from trauma, diabetes, infections and other causes, remains challenging. In this study we describe a new method to create autologous micro-grafts from cutaneous tissue of a single patient and their clinical application. Moreover, in vitro biological characterization of cutaneous tissue derived from skin, de-epidermized dermis (Ded) and dermis of multi-organ and/or multi-tissue donors was also performed. All tissues were disaggregated by this new protocol, allowing us to obtain viable micro-grafts. In particular, we reported that this innovative protocol is able to create bio-complexes composed by autologous micro-grafts and collagen sponges ready to be applied on skin lesions. The clinical application of autologous bio-complexes on a leg lesion was also reported, showing an improvement of both re-epitalization process and softness of the lesion. Additionally, our in vitro model showed that cell viability after mechanical disaggregation with this system is maintained over time for up to seven (7) days of culture. We also observed, by flow cytometry analysis, that the pool of cells obtained from disaggregation is composed of several cell types, including mesenchymal stem cells, that exert a key role in the processes of tissue regeneration and repair, for their high regenerative potential. Finally, we demonstrated in vitro that this procedure maintains the sterility of micro-grafts when cultured in Agar dishes. In summary, we conclude that this new regenerative approach can be a promising tool for clinicians to obtain in one step viable, sterile and ready to use micro-grafts that can be applied alone or in combination with most common biological scaffolds.

Occipital dermoid cyst associated with dermal sinus complicated with meningitis: A case report

Occipital dermal sinus, usually associated with dermoid cyst, is a rare entity; it results from the persistence of an abnormal embryonal communication between the skin and the intradural space. Its main complication is intracranial infection. This 2-year-old girl was hospitalized for meningitis. Neuroradiological studies revealed a cystic mass of the posterior fossa communicating with the skin and hydrocephalus. The diagnosis of dermoid cyst associated with dermal sinus was established at surgery. The patient was treated with radical excision of both the occipital cyst and the dermal sinus associated with systemic antibiotic therapy. She had a good outcome. Posterior fossa dermoid cyst should be considered in all children with chronic occipital skin lesion, especially a dermal sinus. We emphasize the importance of early neurosurgical treatment of dermoid cysts to prevent the development of severe complications.

Differential expression of inflammation-related genes in IL-4 transgenic mice before and after the onset of atopic dermatitis skin lesions

IL-4 plays an important role in the pathogenesis of atopic dermatitis (AD), a common chronic inflammatory skin disease. We have generated IL-4 transgenic (Tg) mice by over-expressing IL-4 in the epidermis. These mice spontaneously develop chronic pruritic inflammatory skin lesions, which meet the clinical and histological diagnostic criteria for human AD. Systemic survey of immune-related genes in this mouse model, however, has not been performed. In this study, we utilize PCR array technique to examine hundreds of inflammation-related genes in the IL-4 Tg mice before and after the onset of skin lesions as well as in their wild type (WT) littermates. Only those genes with at least 2-fold up-regulation or down-regulation and with a P-value of less than 0.05 in comparison to WT controls were identified and analyzed. In the skin lesions, many chemokines, pro-inflammatory cytokines, and other AD-related factors are dysregulated compared to the wild type mice. Particularly, CXCL5, IL-1β, IL-24, IL-6, oncostatin M, PTGS2, FPR1 and REG3γ are up-regulated several hundred-fold. In the pre-lesional group that shows no obvious skin abnormality on clinical observation, 30 dysregulated genes are nevertheless identified though the fold changes are much less than that of the lesional group, including CCL6, CCL8, CCL11, CCL17, CXCL13, CXCL14, CXCR3 and IL-12Rβ2. Finally using ELISA, we demonstrate that 4 most dramatically up-regulated factors in the skin are also elevated in the peripheral blood of the IL-4 Tg mice. Taken together, our data have identified hundreds of dysregulated factors in the IL-4 Tg mice before and after the onset of skin lesions. Future detailed examination of these factors will shed light on our understanding of the development and progression of AD and help to discover important biomarkers for clinical AD diagnosis and treatment.

Treatment of canine atopic dermatitis: 2015 updated guidelines from the International Committee on Allergic Diseases of Animals (ICADA).

BackgroundIn 2010, the International Task Force on Canine Atopic Dermatitis (now International Committee on Allergic Diseases of Animals, ICADA) published the first consensus guidelines for the treatment of atopic dermatitis (AD) in dogs. This is the first 5-year minor update of this document.ResultsThe treatment of acute flares of AD should involve the search for, and then elimination of, the cause of the flares, bathing with mild shampoos, and controlling pruritus and skin lesions with interventions that include topical and/or oral glucocorticoids or oclacitinib. For chronic canine AD, the first steps in management are the identification and avoidance of flare factors, as well as ensuring that there is adequate skin and coat hygiene and care; this might include more frequent bathing and possibly increasing essential fatty acid intake. The medications currently most effective in reducing chronic pruritus and skin lesions are topical and oral glucocorticoids, oral ciclosporin, oral oclacitinib, and, where available, injectable recombinant interferons. Allergen-specific immunotherapy and proactive intermittent topical glucocorticoid applications are the only interventions likely to prevent or delay the recurrence of flares of AD.ConclusionsThis first 5-year minor update of the international consensus guidelines for treatment of AD in dogs further establishes that the treatment of this disease is multifaceted, and that interventions should be combined for a proven (or likely) optimal benefit. Importantly, treatment plans are likely to vary between dogs and, for the same dog, between times when the disease is at different stages.Electronic supplementary materialThe online version of this article (doi:10.1186/s12917-015-0514-6) contains supplementary material, which is available to authorized users.

New World and Old World Leishmania Infections: A Practical Review.

Leishmaniasis is a parasitic infection endemic to more than 90 countries worldwide. As travel to endemic areas increases, dermatologists need to keep this entity in the differential for any chronic skin lesion in persons who may have had a possible exposure for any duration. It can be difficult to diagnose because manifestations are varied and sometimes subclinical. This article discusses the current state of epidemiology, pathogenesis, clinical presentation, diagnosis, and treatment options. A special focus is placed on cutaneous manifestations and their treatment.

Mucocutaneous lupus erythematosus in dogs (21 cases)

The diagnosis of dogs with chronic juxtamucosal erosive lesions and histopathology typical of cutaneous lupus erythematosus (CLE) is unclear. We report herein 21 dogs with mucocutaneous erosive lesions and lupus-specific histopathology that we propose to be affected with mucocutaneous lupus erythematosus (MCLE), another variant of chronic CLE. Inclusion criteria were the presence of the following: (i) a >2 month history of chronic or recurrent skin lesions; (ii) erosions or ulcers predominating at mucosae or mucocutaneous junctions; (iii) microscopic lesions of CLE (i.e. a lymphocyte-rich interface dermatitis with basal keratinocyte damage); and (iv) a lack of complete remission following antimicrobials. Clinical questionnaires and skin biopsies were reviewed. Direct immunofluorescence and antinuclear antibody serology were performed whenever possible. More than half of the 21 dogs were German shepherds or their crosses. The disease affected mostly dogs in their mid-adulthood and there was an over-representation of females. Erosions and ulcers predominated at genital/perigenital and anal/perianal areas, with a lower frequency of involvement of periocular, perioral and perinasal regions. In these dogs, there were no clinical signs suggestive of an associated systemic lupus erythematosus. Microscopic lesions were specific for CLE, but they were patchy and often infected with bacteria. The most common immunological finding was focal IgG deposition at the basement membrane zone. Lesions responded to varying interventions, but oral glucocorticoids led to a shorter time to complete remission. Relapses were common upon treatment tapering. These observations support MCLE being another variant of canine CLE.

Extended implementation of educational programs for atopic dermatitis in childhood.

Children with atopic dermatitis (AD) suffer from chronic relapsing inflammatory skin lesions accompanied by insatiable itching, dryness, excoriated skin, or even (super-)infections. This burden impairs the quality of life of affected children and their families. Due particularly to the recurrent course of the disease, patients often lose confidence in treatment and fear side effects of steroids. Family education programs for AD have been established in the last decades to provide appropriate education and psychosocial support. However, the need for long-lasting strategies in treatment and prevention has even increased. Recent findings not only underline the importance of an intact skin barrier in regard to acute therapy but also suggest that an impairment of skin barrier integrity promotes the development of subsequent atopic diseases in the course of the atopic march. Moreover, in addition to the psychosocial burden due to stigmatized appearance or sleep disturbance, new observations document an increased presence of psychosomatic comorbidities in patients with AD. We reviewed recent educational interventions regarding the theoretical background and here will discuss the heterogeneous approaches of existing programs in childhood. Despite high variations of educational strategies, an overriding aim should be the broader integration of supporting programs in the treatment of children with AD to empower the affected child and its caregiver's to obtain the best possible care, quality of life, and to promote (secondary) prevention.

Ecthyma mimicking cutaneous leishmaniasis

Chronic non-healing ulcerated skin lesion can be a diagnostic dilemma for the dermatologist in an area endemic with cutaneous leishmaniasis. The differential diagnosis may include a large list of cutaneous diseases ranging from infection to advanced skin cancers. Ecthyma is cutaneous infection caused by group A beta-hemolytic streptococci or Staphylococcus aureus bacteria with dermal and subcutaneous invasion. Ecthyma is a differential diagnosis for cutaneous Leishmaniasis presenting as an ulcerated lesion in endemic areas. Being in endemic area for cutaneous leishmaniasis, general physicians and some dermatologist may miss other important and common differential diagnosis, resulting in delay of proper management and increase risk of complications. Our aim in this work is to draw the attentions toward better management while dealing with ulcerated cutaneous lesions. Method: Case reporting. Result: This is a case of a 60 year-old Sudanese male patient who presented with a chronic nonhealing ulcerated lesions at his right forearm for 4 months. The patient was misdiagnosed as a case of cutaneous leishmaniasis and he was treated with anti-leishmanial therapy with no improvement. He was finally diagnosed to have staphylococcal ecthyma that successfully responded to oral antibiotic. Conclusion: Dealing with chronic ulcerated skin lesion requires a carful and detailed history taking and a good knowledge of the common and endemic diseases in the patient’s area supported by proper laboratory studies

Healing effect of a fibrin-based scaffold loaded with platelet lysate in full-thickness skin wounds

Chronic skin lesions are difficult to heal due to reduced levels and activity of endogenous growth factors. The platelet lysate, obtained by repeated freeze–thawing of platelet-enriched blood samples, is an easily attainable source of a wide range of growth factors and bioactive mediators involved in tissue repair. In this study, a bio-synthetic scaffold composed of poly(ether)urethane–polydimethylsiloxane material and fibrin was developed for platelet lysate delivery to chronic skin wounds. The kinetics release and the bioactivity of growth factors released from platelet lysate–loaded poly(ether)urethane–polydimethylsiloxane–fibrin scaffold were investigated, respectively, by enzyme-linked immunosorbent assay and a cell proliferation test using human fibroblasts. The in vitro experiments demonstrated that the platelet lysate–loaded poly(ether)urethane–polydimethylsiloxane–fibrin scaffold provides a sustained release of platelet derived growth factors. The cell growth in the presence of scaffold was comparable to those observed for the platelet lysate added to culture medium in free form, showing that the scaffold preparation process did not affect biological activity of growth factors. The effect of platelet lysate–loaded poly(ether)urethane–polydimethylsiloxane–fibrin scaffold on wound healing in genetically diabetic mouse (db/db) was also investigated. The application of the scaffold on full-thickness skin wounds significantly accelerated wound closure at day 15 post-surgery compared with control poly(ether)urethane–polydimethylsiloxane–fibrin scaffold (without platelet lysate) or a commercially available polyurethane film dressing. Histological analysis demonstrated an increased re-epithelialization, granulation tissue formation, and collagen deposition. The ability of the platelet lysate–loaded poly(ether)urethane–polydimethylsiloxane–fibrin scaffold to promote wound healing in vivo through simultaneous delivery of multiple active substances suggests its potential use for the treatment of diabetic foot ulcers.

Epithelial Cell Death and Inflammation in Skin.

The presence of dying cells in inflamed tissues has been recognized since many years, but until recently cell death was considered primarily a consequence of inflammation. Recent data in mouse models suggest that cell death could provide a potent trigger of inflammation. The identification of necroptosis as a new type of regulated necrotic cell death that is induced by death receptors, toll like receptors and type I interferon receptor indicated that necroptosis could contribute to the proinflammatory properties of these receptors. This is particularly relevant to the skin, a tissue that provides a life-sustaining structural and immunological barrier with the environment and is constantly exposed to mechanical, chemical, and microbial insults. Studies in mouse models showed that sensitization of keratinocytes to apoptosis or necroptosis triggered by TNF and other stimuli causes severe chronic inflammatory skin lesions. In addition, keratinocyte death is a prominent histopathological feature of many inflammatory skin diseases, suggesting that death of epithelial cells could contribute to the pathogenesis of skin inflammation . Here we review recent studies in genetic mouse models providing evidence that keratinocyte death is a potent trigger of skin inflammation and discuss their potential relevance for human inflammatory skin diseases.