Extent Of Skin Lesions Research Articles

Effectiveness of Shel (purgation) with Tshawa-suum (herbal medicine paste) on Langshu: an observational study

Introduction: Skin disease is one of the most common diseases treated at the National Traditional Medicine Hospital in Bhutan. Since the establishment of Inpatient Department in 2018, Shel (purgation) with Tshawa-suum paste application is used as the treatment for Langshu skin disorders. This study was conducted to assess the effectiveness of Shel with Tshawa-suum paste on Langshu. Methods: It was an observational study conducted among patients admitted with Langshu at the National Traditional Medicine Hospital, Thimphu, Bhutan. A structured questionnaire was used to collect the sociodemographic details of the patients and Eczema Area and Severity Index (EASI) score was used to assess the severity and extent of skin lesions. Patients were assessed at three time points: before the treatment, after 7 days of treatment and on day 30 when the patients reported for follow-up care. Results: The mean age of the patients (±SD) was 38.81 (±17.63) years and 57.14% were male. The majority of the patients were farmers (42.43%). At baseline, there were 6 patients with very severe Langshu lesion, 44 with severe and 20 with moderate condition. By day 30, only 3 had severe, 34 had mild and 33 had moderate condition. The study found statistically significant reduction in the mean EASI score from 30.12 on Day 0 to 17.25 on Day 7 and 8.46 on Day 30 (p < 0.001). Conclusions: This study shows that the use of Shel with Tshawa-suum paste resulted in decrease in size and severity of Langshu skin lesions.

Anti-Inflammatory Salidroside Delivery from Chitin Hydrogels for NIR-II Image-Guided Therapy of Atopic Dermatitis.

Atopic dermatitis (AD) is the most common heterogeneous skin disease. Currently, effective primary prevention approaches that hamper the occurrence of mild to moderate AD have not been reported. In this work, the quaternized β-chitin dextran (QCOD) hydrogel was adopted as a topical carrier system for topical and transdermal delivery of salidroside for the first time. The cumulative release value of salidroside reached ~82% after 72 h at pH 7.4, while in vitro drug release experiments proved that QCOD@Sal (QCOD@Salidroside) has a good, sustained release effect, and the effect of QCOD@Sal on atopic dermatitis mice was further investigated. QCOD@Sal could promote skin repair or AD by modulating inflammatory factors TNF-α and IL-6 without skin irritation. The present study also evaluated NIR-II image-guided therapy (NIR-II, 1000-1700 nm) of AD using QCOD@Sal. The treatment process of AD was monitored in real-time, and the extent of skin lesions and immune factors were correlated with the NIR-II fluorescence signals. These attractive results provide a new perspective for designing NIR-II probes for NIR-II imaging and image-guided therapy with QCOD@Sal.

Does daily bathing or showering worsen atopic dermatitis severity? A systematic review and meta-analysis.

The optimal frequency of water bathing/showering in atopic dermatitis (AD) is unknown. We sought to determine the efficacy of different bathing/showering frequencies at improving AD severity. A systematic review and meta-analysis was performed of studies evaluating the clinical efficacy of bathing/showering regimen in AD. MEDLINE, EMBASE, SCOPUS, LILACS, Cochrane, China National Knowledge Infrastructure, Taiwan electronic periodical services and CiNii were searched. Two authors independently performed title/abstract and full-text review and data extraction. All 13 included studies were prospective and demonstrated numerically reduced AD severity in patients treated with a water bathing/showering regimen in ≥ 1 time-point compared with baseline. In random-effects regression models, baths/showers ≥ 7 vs. < 7 times per week were not associated with significant differences of Cohen's D scores for eczema area and severity index (n = 5 studies; least-square means: 1.34 vs. 0.90; P = 0.45; I2 = 91.8), Scoring AD (n = 5 studies; 0.73 vs. 0.41; P = 0.13; I2 = 97.4) or body surface area (n = 4 studies; 0.45 vs. 0.28; P = 0.17; I2 = 93.4). Similar results were observed in sensitivity analyses by study design, quality, use of emollients, and use of topical corticosteroids. No publication bias was detected by Egger regression (P ≥ 0.26) or Begg rank (P ≥ 0.19) tests. Three studies were included in the qualitative analysis, which found that bathing/showering ≥ 7 resulted in significant improvement of Investigator Global Assessments, extent of skin lesions and itch caused by AD. In conclusion, the optimal frequency of water bathing/showering in AD remains unclear. Daily showers/baths were not associated with worse severity, and should be permitted in AD. Larger scale, well-designed RCT are still needed to determine the optimal bathing parameters.

Possibilities of screening for a high-risk axial skeletal lesion in psoriatic arthritis

Objective: to determine a set of signs that are prognostically significant for identifying a high-risk axial skeletal lesion in early psoriatic arthritis (ePsA).Patients and methods. Examinations were made in 95 patients (47 men and 48 women) with peripheral arthritis lasting for ≤2 years, who met the 2006 Classification Criteria for Psoriatic Arthritis (CASPAR). The clinical characteristics of the patients were presented in our previously published work. In all the patients, a standard examination was made and the signs of inflammatory back pain (IBP) were identified according to the Assessment of SpondyloArthritis International Society (ASAS) criteria, the presence of human leukocyte antigen B27 (HLA-B27) was determined, and pelvic bone X-ray was done; regardless of whether they had IBP, 79 patients underwent magnetic resonance imaging (MRI) of the sacroiliac joints using a low-field Signa Ovation 0.35 T. Sacroiliitis (SI) diagnosed based on radiography (rSI) was considered reliable if there were bilateral changes corresponding to at least Stage II or unilateral changes corresponding to at least Stage III according to the Kellgren system. SI diagnosed based on MRI (MRI-SI) was regarded as active when osteitis was detected in the STIR mode in the bones adjacent to the joint on at least two slices or in the presence of two signals in a slice. X-ray and MRI results were assessed by an independent radiologist. The extent of a skin lesion was determined from the body surface area (BSA): the extent was regarded insignificant, moderate, and significant with involvements of &lt;3%, 3–10%, and &gt;10%, respectively.The patients were divided into two groups. Group 1 included 65 (68.4%) patients with the manifestations of axial PsA (axPSA): IBP, and/or rSI, and/or MRI-SI; Group 2 consisted of 30 (31.6%) patients without axial manifestations, only with peripheral PsA (pPsA). Multivariate stepwise discriminant analysis was used to identify a group of signs that were most characteristic of axPsA.Results and discussion. Comparative analysis of the two groups showed that there were more males among patients with axPsA than among those with pPsA (39 (60%) and 8 (26.7%), respectively) (p=0.003). HLA-B27 positivity was also more often detected in patients with axPSA than in those with pPsA (30 (46.6%) and 7 (23.3%) patients, respectively) (p=0.02). In the axPSA group, there were significantly more individuals with moderate and high DAS, high CRP levels, and a more severe skin lesion (BSA &gt;3%).The investigators obtained the following discriminant classification rule associated with axPSA: 1.566 (if CRP is &gt;5 mg/L) + 0.957 (if HLA-B27 is positive) + 0.986 (if BSA is &gt;3%) + 1.845 (if DAS is moderate or high) + 0.6 (if the sex is male) &gt;3.751 (p=0.0025). The sensitivity and specificity of the model were 68% and 73%, respectively.Conclusion. The combination of signs, such as male sex, HLA-B27 positivity, high or moderate DAS, CRP &gt;5 mg/L, the extent of skin lesions according to BSA &gt;3%, is prognostically significant for identifying high-risk axial skeletal lesion in ePSA. The proposed mathematical model can be used to screen patients for the early diagnosis of an axial lesion in ePSA.

Nasal Colonization by Staphylococci and Severity of Atopic Dermatitis.

Skin colonization by Staphylococcus aureus (SA) correlates with increased severity of atopic dermatitis (AD). The role of nasal SA carriage and coagulase-negative staphylococci (CNSs) in AD is unclear. The aim of this study was to assess the influence of colonization of lesional/nonlesional skin and the anterior nares by SA and CNSs on AD severity in 63 adult patients. Disease severity was assessed with SCORAD index. The total immunoglobulin E (IgE) concentration was determined using the enzyme-linked immunosorbent assay method. The prevalence and abundance of staphylococci were assessed with the combination of bacterial culture and mass spectrometry. The prevalence values of SA within the skin (lesional/nonlesional) and anterior nares were 79.4%/61.9% and 69.8%, respectively (vs 5.6% and 13.9%, respectively in controls, P < 0.0001). The carriage of CNSs in all niches was associated with lower mean IgE concentration (1164.66 ± 1010.36 vs 1762.99 ± 1059.15, P < 0.0213; 1166.9 ± 1006.4 vs 2152.7 ± 759.2, P < 0.0063; 1022 ± 1100 vs 1925 ± 880.8, P < 0.0044, respectively). The abundance of SA correlated with the extent of skin lesions and total IgE (ρ = 0.42, P = 0.0007; ρ = 0.488, P < 0.0001; ρ = 0.312, P < 0.2; and ρ = 0.402, P = 0.0007; ρ = 0.403, P < 0.002; ρ = 0.287, P < 0.03, respectively). Atopic dermatitis severity correlates with both cutaneous and nasal colonization by SA. Staphylococcus aureus seems to promote TH2-type response, whereas CNS probably limits this process. Preventive measures within the anterior nares should be considered for AD patients.

Serum galectin-3 and galectin-3 binding protein levels in systemic lupus erythematosus and cutaneous lupus erythematosus.

IntroductionThe roles of galectin-3 (Gal-3) and galectin-3 binding protein (G3BP) in systemic lupus erythematosus (SLE) are of ongoing interest, but the data are insufficient due to highly limited available studies. There are no data on cutaneous lupus erythematosus (CLE).AimTo assess serum Gal-3 and G3BP concentrations in SLE patients with and without LE-specific skin lesions, CLE patients and to correlate levels of proteins with clinical and laboratory parameters.Material and methodsThe study included 71 SLE patients with and without LE-specific skin lesions, 23 CLE patients and 40 controls. Gal-3 and G3BP were measured by specific enzyme-linked immunosorbent assays (ELISA).ResultsSerum Gal-3 and G3BP concentrations were significantly higher in SLE with and without LE-specific lesions compared to controls, but without differences between SLE groups. Gal-3 and G3BP levels were also elevated in CLE compared to controls (p = 0.001, p = 0.005; respectively). There was a positive correlation between G3BP level and CLASI activity score both in CLE (r = 0.55, p = 0.006) and in SLE patients with LE-specific lesions (r = 0.36, p = 0.02). G3BP and Gal-3 levels did not differ in SLE with LE-specific lesions and CLE. There was a positive correlation between serum G3BP level and the SLEDAI score in SLE patients (r = 0.26, p = 0.03).ConclusionsOur findings indicate that serum G3BP and Gal-3 are elevated in CLE. Additionally, G3BP might be associated with the extent of skin lesions. There are no differences between G3BP and Gal-3 concentrations in SLE with and without LE-specific skin lesions.

Detection of systemic sclerosis in patients with pulmonary hypertension

Introduction. The problem of early detection of pulmonary arterial hypertension (PAH) is closely related to the diagnosis of systemic sclerosis (SSc). It is especially important in patients with slight manifestations of the disease, making it diffcult to verify the diagnosis before the clinic of right ventricular heart failure, and low knowledge of the general practitioners of the available diagnostic opportunities.The aim of the work was to identify the earliest clinical signs of PAH associated with SSc for its early diagnosis.Material and methods. The study included 51 patients with limited SSc. The investigators evaluated the extent of skin lesion, levels of the level of N­terminal brain natriureticpropeptide (NT­proBNP) and uric acid, the fluorescent pattern and titer of antinuclear factor. All patients underwent an echocardiography, nailfold videocapillaroscopy, a comprehensive assessment of external respiratory functions. When there were symptoms of PAH, right heart catheterization was performed to confrm it.Results. PAH was detected in 19 of the 51 patients included in the study. Patients with PAH were signifcantly older than those without PAH: (60±8) and (54±7) years, respectively (p=0.02); there were also differences between these groups in the signs of right cardiac remodeling (p&lt;0.05), in the indices estimated in the six­minute walk test (p&lt;0.05), in the assessment of lung diffusing capacity (p&lt;0.001), in levels of NT­proBNP and uric acid (p&lt;0.001), in the density of the nailfold capillaries (p=0.009); in a semiquantitative assessment of nailfold capillary alterations (p=0.022). Among patients with PAH associated with SSc, seven patients were diagnosed with SSc for the frst time after referring to cardiologists and verifying the genesis of PAH, while other 12 patients were previously observed by rheumatologists. Differences in the duration of the period from the onset of symptoms to the diagnosis of SSc (p=0.043) were revealed between these groups.Conclusion. The study shows the probability of the presence of SSc in patients with suspected idiopathic PAH, that determines the necessity of additional immunological and instrumental examinations in such patients.

VALUES OF VASCULAR ENDOTHELIAL GROWTH FACTOR IN THE PATHOGENESIS OF ATOPIC DERMATITIS IN CHILDREN

The article presents the results of the vascular endothelial growth factor study in children suffering from atopic dermatitis. Changes in its concentration are analyzed depending on the degree of severity and duration of the disease, the extent of skin lesions and the severity of clinical manifestations.

Tissue Destruction in Bullous Pemphigoid Can Be Complement Independent and May Be Mitigated by C5aR2.

Bullous pemphigoid (BP), the most frequent autoimmune bullous disorder, is a paradigmatic autoantibody-mediated disease associated with autoantibodies against BP180 (type XVII collagen, Col17). Several animal models have been developed that reflect important clinical and immunological features of human BP. Complement activation has been described as a prerequisite for blister formation, however, the recent finding that skin lesions can be induced by anti-Col17 F(ab′)2 fragments indicates complement-independent mechanisms to contribute to blister formation in BP. Here, C5−/− mice injected with anti-Col17 IgG showed a reduction of skin lesions by about 50% associated with significantly less skin-infiltrating neutrophils compared to wild-type mice. Reduction of skin lesions and neutrophil infiltration was seen independently of the employed anti-Col17 IgG dose. Further, C5ar1−/− mice were protected from disease development, whereas the extent of skin lesions was increased in C5ar2−/− animals. Pharmacological inhibition of C5a receptor 1 (C5aR1) by PMX53 led to reduced disease activity when applied in a prophylactic setting. In contrast, PMX-53 treatment had no effect when first skin lesions had already developed. While C5aR1 was critically involved in neutrophil migration in vitro, its role for Col17-anti-Col17 IgG immune complex-mediated release of reactive oxygen species from neutrophils was less pronounced. Our data demonstrate that complement-dependent and -independent mechanisms coexist in anti-Col17-autoantibody-mediated tissue destruction. C5aR1 and C5aR2 seem to play opposing roles in this process with C5aR1 exerting its primary effect in recruiting inflammatory cells to the skin during the early phase of the disease. Further studies are required to fully understand the role of C5aR2 in autoantibody-mediated skin inflammation.

Mycosis Fungoides of the Liver

The following case describes a patient with hepatic mycosis fungoides with lack of concurrent cutaneous involvement. A 66-year-old woman presented to an outpatient clinic with an unintentional thirty-pound weight loss over a six-month period. Past medical history was most notable for cutaneous mycosis fungoides treated with total body light therapy over ten years prior with complete remission of symptoms. EGD and colonoscopy were performed given the weight loss and these displayed large gastric and esophageal varices. A CT abdomen/pelvis showed a nodular liver contour, esophageal, paraesophageal, and omental varices with a dilated portal vein. The patient underwent a transjugular liver biopsy with hepatic hemodynamics showing a hepatic portal venous gas of 8-10 mmHg and pathology revealing a clonal population of T-cell rearrangement infiltrate. The patient was referred to hematology for possible hepatic T-cell lymphoma, however liver biopsy staining, bone marrow biopsy, and a PET scan demonstrated findings most consistent with mycosis fungoides of the liver. Mycosis fungoides is an uncommon variant of non-Hodgkin lymphoma of T cell origin with unknown etiology. Though it is most commonly characterized by cutaneous manifestations, it can ultimately involve the blood, lymph nodes, and visceral organs. Lymph nodes are the most commonly affected extracutaneous site, but hepatic, splenic and renal involvement has been documented in the literature. While extracutaneous disease typically correlates with extent of skin lesions, there may be lack of concurrent cutaneous and visceral involvement, as with our patient. With hepatic mycosis fungoides, there are often no overt clinical signs of liver dysfunction, so clinicians must be aware of the patient's past medical history in order to facilitate an early, accurate diagnosis.

Clinical and Patient-reported Outcomes in Patients with Psoriatic Arthritis (PsA) by Body Surface Area Affected by Psoriasis: Results from the Corrona PsA/Spondyloarthritis Registry.

Psoriatic arthritis (PsA) is commonly comorbid with psoriasis; the extent of skin lesions is a major contributor to psoriatic disease severity/burden. We evaluated whether extent of skin involvement with psoriasis [body surface area (BSA) > 3% vs ≤ 3%] affects overall clinical and patient-reported outcomes (PRO) in patients with PsA. Using the Corrona PsA/Spondyloarthritis Registry, patient characteristics, disease activity, and PRO at registry enrollment were assessed for patients with PsA aged ≥ 18 years with BSA > 3% versus ≤ 3%. Regression models were used to evaluate associations of BSA level with outcome [modified minimal disease activity (MDA), Health Assessment Questionnaire (HAQ) score, patient-reported pain and fatigue, and the Work Productivity and Activity Impairment questionnaire score]. Adjustments were made for age, sex, race, body mass index, disease duration, and history of biologics, disease-modifying antirheumatic drug, and prednisone use. This analysis included 1240 patients with PsA with known BSA level (n = 451, BSA > 3%; n = 789, BSA ≤ 3%). After adjusting for potential confounding variables, patients with BSA > 3% versus ≤ 3% had greater patient-reported pain and fatigue and higher HAQ scores (p = 2.33 × 10-8, p = 0.002, and p = 1.21 × 10-7, respectively), were 1.7× more likely not to be in modified MDA (95% CI 1.21-2.41, p = 0.002), and were 2.1× more likely to have overall work impairment (1.37-3.21, p = 0.0001). These Corrona Registry data show that substantial skin involvement (BSA > 3%) is associated with greater PsA disease burden, underscoring the importance of assessing and effectively managing psoriasis in patients with PsA because this may be a contributing factor in PsA severity.

ROLE OF VASCULAR ENDOTHELIAL GROWTH FACTOR IN THE PATHOGENESIS OF ATOPIC DERMATITIS IN CHILDREN

The article presents the findings of the study of vascular endothelial growth factor in children suffering from atopic dermatitis. The changes in its concentration were analyzed depending on the degree of severity and duration of the disease, the extent of skin lesions and the severity of clinical manifestations.

Can immunosuppressive therapy facilitate the diagnosis and affect the clinical signs of canine scabies? A retrospective study of 79 cases.

Scabies infestation is one of the most pruritic dermatoses of dogs. It is often misdiagnosed and dogs are treated with immunomodulatory drugs (IMD) to relieve pruritus. The primary goals of this study were to determine the impact of IMD on skin scraping results, pruritus level and extent of skin lesions, and to evaluate whether disease duration is associated with positive skin scrapings and contagion. Seventy nine dogs with a final diagnosis of scabies. Inclusion in this retrospective study required a positive skin scraping for scabies or a clinical response to an acaricidal treatment trial. The average pruritus score of dogs that received IMD (8.71) was significantly higher than those that did not (7.43; P = 0.03). However, there were no significant differences in either the rates of positive skin scrapings (79.6% versus 59.1%; P = 0.13) or the mean number of body sites affected (3.8 versus 3.4; P = 0.30) between dogs that received IMD and those that did not. Neither skin scraping status nor duration of clinical signs were correlated with a report of contagion within the household. IMD was associated with a significant increase in the pruritus level, but not with the mean number of lesional body sites. Dogs exposed to IMD had a 20.5% higher rate of positive skin scrapings. This difference could be clinically relevant and lack of statistical significance may indicate an underpowered study.

Current treatments and developments in pemphigoid diseases as paradigm diseases for autoantibody-driven, organ-specific autoimmune diseases

Pemphigoid diseases constitute a group of difficult-to-treat, remitting-relapsing autoimmune skin diseases. They are autoantibody-driven diseases with well-defined autoantigens in the hemidesmosomal complex at the dermal–epidermal junction (DEJ). Autoantibody deposition initiates the recruitment of granulocytes to the DEJ, where these cells degrade the hemidesmosomal complex, disrupting dermal-epidermal adherence, which clinically manifests as blisters and erosions. Due to their well-defined autoantigens and the location at the body surface, allowing the direct observation of inflammation throughout its course, pemphigoid diseases are excellent paradigm diseases to study the pathomechanisms of autoantibody-driven diseases. Current treatments of pemphigoid diseases largely rely on systemic immunosuppression despite the restriction of inflammation to the skin. The iatrogenic immunosuppression may contribute to the high 1-year mortality rate in pemphigoid diseases. Thus, the overall survival does not depend on the extent of skin lesions before treatment, but depends on whether topical or systemic glucocorticoid application is initially used. Systemic glucocorticoid application is linked to higher mortality than topical application, illustrating that systemic immunosuppression can harm the overall prognosis and that immunomodulatory treatment strategies are required. New mouse models of pemphigoid diseases have been instrumental in approaching the introduction of novel immunomodulatory therapies in the treatment of autoimmune diseases.

Caspase-1-independent IL-1 release mediates blister formation in autoantibody-induced tissue injury through modulation of endothelial adhesion molecules.

Although reports documented aberrant cytokine expression in autoimmune bullous dermatoses (AIBDs), cytokine-targeting therapies have not been established in these disorders. We showed previously that IL-6 treatment protected against tissue destruction in experimental epidermolysis bullosa acquisita (EBA), an AIBD caused by autoantibodies to type VII collagen (COL7). The anti-inflammatory effects of IL-6 were mediated by induction of IL-1ra, and prophylactic IL-1ra administration prevented blistering. In this article, we demonstrate elevated serum concentrations of IL-1β in both mice with experimental EBA induced by injection of anti-COL7 IgG and in EBA patients. Increased IL-1α and IL-1β expression also was observed in the skin of anti-COL7 IgG-injected wild-type mice compared with the significantly less diseased IL-1R-deficient or wild-type mice treated with the IL-1R antagonist anakinra or anti-IL-1β. These findings suggested that IL-1 contributed to recruitment of inflammatory cells into the skin. Accordingly, the expression of ICAM-1 was decreased in IL-1R-deficient and anakinra-treated mice injected with anti-COL7. This effect appeared to be specifically attributable to IL-1 because anakinra blocked the upregulation of different endothelial adhesion molecules on IL-1-stimulated, but not on TNF-α-stimulated, cultured endothelial cells. Interestingly, injection of caspase-1/11-deficient mice with anti-COL7 IgG led to the same extent of skin lesions as in wild-type mice. Collectively, our data suggest that IL-1, independently of caspase-1, contributes to the pathogenesis of EBA. Because anti-IL-1β in a prophylactic setting and anakinra in a quasi-therapeutic setting (i.e., when skin lesions had already developed) improved experimental EBA, IL-1 appears to be a potential therapeutic target for EBA and related AIBDs.

Determinants of Central Nervous System Involvement in Herpes Zoster

Background: Herpes zoster is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body, often in a stripe. Central nervous system(CNS) involvements are uncommon complications of herpes zoster. The exact mechanism and risk factors are still unknown. Methods: We retrospectively reviewed the clinical data of patients who was admitted at our hospital due to herpes zoster from 2003 to 2013. The patients under age 15, herpes zoster infection without skin lesions, and cases not confirmed by a dermatologist were excluded. CNS involvements are defined as meningitis, encephalitis, single or multiple cranial neuropathies and all cases were evaluated with brain magnetic resonance imaging, spinal tapping, serological tests and confirmed by a neurologist. We compared the herpes zoster patients with CNS involvement to those without CNS involvement. Age, sex, body mass index, associated chronic medical illnesses, site and extent of skin lesion and development of post herpetic neuralgia were compared between two groups. Results: Total 1,131 subjects (male 460, female 671) were recruited. A group with CNS involvement was 91(8.04%). Sex, body mass index, associated chronic medical illnesses, extent of skin lesion were not different between two groups. A group with CNS involvement showed younger age(p<0.01), more facial and cervical skin lesions(p<0.01), lesser development of post herpetic neuralgia(p=0.048). Conclusions: CNS involvement is not a rare complication of herpes zoster and more frequent in patients with younger age and faciocervical zoster. J Korean Neurol Assoc 33(1):13-17, 2015

Itching sensation in psoriatic patients and its relation to body mass index and IL-17 and IL-31 concentrations.

IntroductionAccording to available data, pruritus is a common symptom of psoriasis, however its characteristics and pathogenesis are not clearly understood.AimThe main aim of this study was to assess itching sensation among patients suffering from psoriasis, including its incidence and severity. All factors triggering and worsening pruritic symptoms were also carefully analyzed. The authors assessed the relationship of itch with body mass index (BMI) and severity of disease. Moreover, serum levels of interleukin 17 (IL-17) and IL-31 were analyzed in relation to Psoriasis Activity and Severity Index, BMI and severity of pruritus.Material and methodsThe study group consisted of 60 patients with plaque-type psoriasis. Analysis of impact of pruritus on the quality of life and worsening factors was based on the questionnaire. The severity of pruritus was assessed with the use of two independent scales. Serum IL-17 and IL-31 levels were measured in 30 patients suffering from psoriasis and in 10 healthy controls using immunoassay tests.Results88.3% of analyzed patients complained of itch and the most common factor which exacerbated pruritus was stress (39.6%). Pruritus in psoriasis was independent of gender, illness duration and extent of skin lesions. The average intensity of pruritus was assessed as moderate and did not correlate significantly with BMI level, IL-17 and IL-31.ConclusionsSince the pathogenesis of pruritus in psoriasis is not fully understood, further investigation in this area needs to be conducted. Pruritus may be considered as a characteristic feature of psoriasis and, besides the skin lesions, should be a target in dermatological treatment to improve patient's quality of life.

Treatment and control of bovine sarcoptic and psoroptic mange infestation with ivermectin long-acting injectable (IVOMEC(®) GOLD).

The efficacy of ivermectin long-acting injection (IVM LAI, IVOMEC® GOLD, Merial; 3.15 % ivermectin w/v) formulation was evaluated in cattle with induced Sarcoptes scabiei var. bovis or Psoroptes ovis infestations. A total of 64 cattle were included in this series of four studies, with 16 animals per study. Approximately, 8 weeks following initial induced mite infestation, cattle were allocated to treatment groups based on decreasing pre-treatment bodyweights. Treatments (saline (control) or IVM LAI (630 mcg ivermectin/kg bodyweight) at 1 mL/50 kg bodyweight) were administered by a single subcutaneous injection in front of the right shoulder on Day 0. Skin scrapings were collected prior to treatment and at approximately weekly intervals for 8 weeks thereafter to establish live mite counts. Character and extent of skin lesions were evaluated at each sampling. Animals were weighed before treatment and at the end of the studies. Mite counts of the IVM LAI-treated animals were significantly (p < 0.05) lower than those of the controls in all four studies at all occasions post-treatment. In the two Sarcoptes studies, IVM LAI-treated cattle were free of mites at 14 days after treatment and in the Psoroptes studies at 13 or 28 days post-treatment. All IVM LAI-treated cattle remained free of mites to the end of the studies while all control animals remained infested. Mange lesions of the IVM LAI-treated animals improved significantly (p < 0.05) compared to those of the controls from Day 21 (Sarcoptes studies) and from Days 28 or 34 (Psoroptes studies). In all studies, mean weight gain over the 8 week post-treatment period was significantly (p < 0.05) higher for the IVM LAI-treated animals than for the controls: Sarcoptes studies, 64.1 and 68.6 kg vs. 46.9 and 48.6 kg, respectively; Psoroptes studies, 43.0 and 43.4 kg vs. 20.8 and 34.9 kg, respectively. All animals accepted the treatment well, and no treatment-related health problems and adverse events were observed throughout the studies. These studies demonstrated the high efficacy of IVOMEC® GOLD against sarcoptic and psoroptic mange in cattle.

Thyroid Disease and Indicator of Autoimmune Illness among Vitiligo Patients

Background: The precise pathogenesis remains not fully understood. However, it is thought to involve an autoimmune process directed against melanocytes. Thyroid disorders and autoimmune thyroid diseases have been shown in some reports to be associated with vitiligo. Additionally, there is limited and conflicting data examining the association of antinuclear antibodies (ANA) with vitiligo. Methods: We conducted a cross-sectional study among 50 vitiligo patients diagnosed according to established clinical criteria at King Khalid University Hospital, Riyadh from January 2008 through December 2010. Blood samples were obtained from the study participants and were tested for antinuclear antibodies (ANA), thyroid stimulating hormone (TSH) and free thyroxin hormone (T4). Results: Males represented 62% and the mean age was 28.2±11.0 years. A total of 20 (41.7%) had positive ANA values (titer ≥1:40). The mean TSH level was 2.69±2.17 µIU/mL. The mean free T4 level was 16.40±2.74 pmol/L and all patients were in the normal range (10.3-25.8 pmol/L). There were no statistically significant associations between ANA and age, gender, extent of skin lesion, face inclusion, and free thyroxin levels. On the other hand, positive ANA level had significant association with TSH level (p=0.041). With exception of ANA, TSH level had no statistically significant associations with the above variables. Conclusions: The results of the current study showed higher prevalence of ANA in vitiligo patients, probably suggesting autoimmune process. The current finding may need to be confirmed in a larger prospective multicentric study before recommending periodic screening of patients with vitiligo for thyroid function and antithyroid antibodies.

Toxic epidermal necrolysis after linezolid administration:Case report

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are severe skin reactions characterised by epider-mal necrolysis. Skin reactions develop as a result of drug induced keratinocyte apoptosis. Certain drugs, like nonsteroidal anti-inflammatory agents, antimicrobial substances and anticonvulsants, cause TEN or SJS more frequently. We present the case of a fatal adverse cutaneous reaction after linezolid administration in a 66-year old patient with severe staphylococcal pneumonia during treatment in the intensive care unit. According to data from the National Agency for Medicinal Products and Medical Devices of Croatia (HALMED), TEN is a rare, but not an unexpected, side effect of this antimicrobial drug. Time of occurrence, distribution and the extent of skin lesions are not typical of TEN, but the result of the postmortal skin biopsy clearly indicates the cause of the reaction.