Skin Areas Of Patients Research Articles

Assessment of Skin by High Frequency Musculoskeletal Ultrasound in Egyptian Patients with Systemic Sclerosis

Abstract Background Fibrotic involvement of the skin is a cardinal feature of systemic sclerosis (SSc). The extent of skin involvement is associated with internal organ involvement with severe disease course and poor prognosis. SSc skin involvement is characterized by three phases in temporal sequence: edematous, fibrotic, and atrophic. A palpation-based semi- quantitative score, the modified Rodnan skin score (mRSS) is widely used for the assessment of skin involvement. It is a quick, noninvasive clinical assessment that correlates with histological grading of skin fibrosis. However, it lacks the sensitivity to differentiate between clinically indistinguishable pathological phases such as inflammatory edema vs. established fibrosis. More objective approaches to measure skin involvement imaging have been developed in the past decades.In our study, we review the use of ultrasound for the assessment of early changes in skin thickness and echogenicity in patients with SSc, focusing. mainly on high frequency ultrasound. Aim of the Work to evaluate the role of high frequency ultrasound (HFUS) of skin in assessment of early changes in skin thickness and echogenicity in patients with SSc. Patients and Methods Our study is a cross-sectional, observational study involving homogenous groups consisting of 23 SSc patients and 21 healthy age and sex matched controls. Patients who fulfilled the 2013 ACR/EULAR Classification Criteria for SSc. Results DT was evaluated by both mRSS and HFUS at 5 skin areas in both patients and control. We found statistically significant difference between the two studied groups as regards in area 1 longitudinal (P = 0.017) and area 1 in transverse (P = 0.038), tendency to significance in area 2 (P = 0.054). Subclinical dermal involvement was detected by HFUS even in the skin areas in patients who had a normal local MRSS ( These areas were not planned to be assessed by high frequency ultrasound but added to the five areas to be assessed to evaluate for ultrasound detected subclinical involvement of skin in SSc patients ). In particular, DT was highly significantly greater in patients with area with Rodnan zero score at dorsum of hand than in healthy subjects (longitudinal and transverse) (P < 0.001, 0.005 ) respectively. Similar changes at the level of echogenicity occurred in determination of the stage of the disease, with increased skin thickness and decreased echogenicity occurring early and during skin disease activity due to edema; and decrease skin thickness and increased echogenicity occurring late with skin atrophy Conclusion that high frequency ultrasound is a useful tool in assessment of skin pathologic changes (even subclinical changes) in terms of thickness and echogenicity in patients with SSc both at disease onset and during follow up of response to therapy and disease stage. Moreover, it could be a useful screening tool with definite cutoff values at certain areas that differentiate normal from pathologic skin thickness.

Hair Shaft Abnormalities as a Dermoscopic Feature of Mycosis Fungoides: Pilot Results.

Diagnosis of persistent erythematous, scaly patches, or plaques can be complex since psoriasis (Ps), eczematous dermatitis (ED), and mycosis fungoides (MF) can be considered. Dermoscopy, which is a noninvasive diagnostic tool, is commonly used to examine blood vessels, scales, and background color; however, research on hair shaft evaluation in inflammatory dermatoses remains scarce. The aim of the study was dermoscopic evaluation of hair shafts in skin lesions localizedon thenon-scalp skin areas in patients diagnosed with MF, Ps, and ED. This was a retrospective evaluation of 55 patients diagnosed with MF, Ps, and ED. Photographic anddermoscopic documentation of these patients and detailed medical history were evaluated. A total of 21 patients with MF, 21 patients with Ps, and 13 patients with ED were evaluated. The examination revealed the presence of various abnormalities of hair shafts (e.g., numerouspili torti, singlepili torti, 8-shaped hairs, pigtail hairs, broken hairs, hair shafts rapidly tapered over long sections, hair shafts irregular in thickness, angulated hairs, branched hairs,the presence of trichorrhexis nodosa,and monilethrix-like hairs), yellow dots, and black dots. The presence ofpili tortiwas found in 80% of patients with MF, compared with 16% of patients with Ps and 8% of patients with ED (p < 0.005), with multiplepili tortifound only in MF patients (67%) (p < 0.005). Statistically significant differences also applied to hair shafts rapidly tapering over long sections and 8-shaped hairs, which occurred only in MF patients (p < 0.005 and p = 0.035, respectively). The presence of hair shaft abnormalities such as numerous pili torti, 8-shaped hairs, and hair shafts rapidly tapering over long sections is an important criterion that should be considered in the dermoscopic differentiation of the patchy/plaque mycosis fungoides and inflammatory dermatoses, such as psoriasis and eczematous dermatitis localizedon thenon-scalp skin areas.

Transcutaneous bilirubin measured on protected skin during phototherapy in term and preterm neonates

BackgroundTranscutaneous bilirubin (TCB) measurement is a simple, painless, and time-saving alternative for the assessment of TSB (total serum bilirubin) levels. However, TCB measurements obtained during phototherapy can yield inaccurate results. We evaluated the effectiveness of TCB measurements obtained from protected skin areas in patients who underwent phototherapy. MethodsThis prospective study included neonates delivered at a gestational age of ≥340/7 weeks. TCB measurements were performed at the forehead and the lower end of the sternum using a JM-105 device. Simultaneously, blood samples were collected to determine TSB levels. During phototherapy, the forehead was covered with a photo-opaque patch. TSB and TCB were measured before, during, at the end of, and after phototherapy. ResultsIn total, 200 neonates, including 110 (55 %) term and 90 (45 %) late preterm infants, were enrolled. Of these neonates, 162 (81 %) were Turkish while 38 (19 %) were refugees from Syria and Iraq. Notably, no statistically significant differences were observed in the TSB and TCB values between the Turkish and refugee groups (p > 0.05). Bland–Altman analysis was conducted between the TCB values obtained from the covered forehead area and TSB values; the analysis revealed moderate, high, and excellent agreements for the first bilirubin measurement and at the end of phototherapy, before phototherapy, and for the second and rebound bilirubin measurements, respectively. Regarding intraclass correlation coefficients, values >0.95, 0.94–0.85, 0.84–0.70, and < 0.7 indicated perfect, high, moderate, and unacceptable compatibilities, respectively. Although a significant association was observed between pre-phototherapy TCB obtained from the sternum and TSB levels, no significant associations were observed during phototherapy. ConclusionsOur findings indicate that the consistency observed between TCB measurements obtained from the protected skin areas and TSB values can be used to monitor phototherapy effectiveness, particularly in late preterm/term infants and those with darker skin tones. Furthermore, this approach can aid in guiding decisions related to treatment termination, evaluating rebound bilirubin levels, minimizing costs, and providing a less invasive testing option.

Микробиоценоз кожи у военнослужащих с абсцедирующим фурункулом челюстно-лицевой области

INTRODUCTION: Among non-odontogenic inflammatory diseases of the maxillofacial region, most common are abscessed furuncles. The causative agent of the disease is S. aureus (95%) mostly occurring as a monoculture. AIM: To study the microbial flora of facial skin in military personnel with abscessed furuncle of the maxillofacial region. MATERIALS AND METHODS: In 53 patients with abscessed facial furuncles (the main group) aged from 18 to 25 years, material was taken for bacteriological examination from healthy areas of the skin and from the furuncle with a sterile cotton swab. As a comparison group, a group of 30 practically healthy individuals of the same age was recruited, who also underwent a microbiological examination of facial skin areas. Examinations were performed in the bacteriological laboratory of Kirov Military Medical Academy. RESULTS: Among the representatives of the microflora of healthy skin areas in patients with abscessed furuncles of the face, S. epidermidis was detected in 58% of cases, S. saprophyticus in 33%, S. haemoliticus in 10%. In 30% of admitted patients, Propionibacterium acnes were found. In 4% of cases, S. aureus was detected by us. Fungi of the genus Candida were found in 5% of patients. The microbial composition of the wound discharge in facial furunculosis in 87% of cases was represented by pathogenic S. aureus as a monoculture, in 4% in association with S. saprophyiticus, in 3% with Pseudomonas aeruginoza, in 1% in association with Klebsiella oxytoca, in 5% by S. epidermidis as a monoculture. The species composition of the microflora of the facial skin of healthy people was represented by non-pathogenic staphylococci S. epidermidis (88.1%), S. saprophyticus (40%). In 25.3% of cases, streptococci were also detected. In 10% of cases, yeast-like fungi of Malassezia genus and in 12% of Candida genus were found. In 4% of cases, the pathogenic form of S. aureus was identified. CONCLUSION: The revealed differences in the composition of microorganisms of healthy skin areas between healthy individuals and patients with abscessed facial furuncles permitted to suggest the presence of dysbacteriosis of skin of the maxillofacial region in patients with abscessed furuncles, which led to the development of the disease.

Non-Neuronal Kappa Opioid Pathway Profiling in the Skin of Different Chronic Pruritus–Associated Dermatoses

Recent studies argue for an important role of peripheral opioidergic signaling including cutaneous pathways in inflammation, neurons and itch ( Ádám et al., 2022 Ádám D Arany J Tóth KF Tóth BI Szöllősi AG Oláh A Opioidergic Signaling—A Neglected, Yet Potentially Important Player in Atopic Dermatitis. Int J Mol Sci. MDPI. 2022; Google Scholar ). Signal transduction induced by synthetic opiates and endogenous opioid peptides takes place via three types of opioid receptors (OR), the μ-OR (MOR), δ-OR (DOR) and the κ-OR (KOR) ( Tominaga et al., 2007 Tominaga M, Ogawa H, Takamori K. Possible Roles of Epidermal Opioid Systems in Pruritus of Atopic Dermatitis. Journal of Investigative Dermatology. Elsevier Masson SAS; 2007;127(9):2228–2235 Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022202X15335387 Google Scholar ). A specific agonist/receptor combination is usually preferred for activation of the signaling cascade, e.g. morphine/MOR and dynorphin/KOR ( Snyder et al., 2018 Snyder LM, Chiang MC, Loeza-Alcocer E, Omori Y, Hachisuka J, Sheahan TD, et al. Kappa Opioid Receptor Distribution and Function in Primary Afferents. Neuron. Elsevier Inc.; 2018;99(6):1274-1288.e6 Available from: https://doi.org/10.1016/j.neuron.2018.08.044 Google Scholar ). The nervous system is the predominant site of opioid receptor expression including their endogenous agonists (Rogers 2020). However, these can also be found in non-neuronal peripheral cells of the skin ( Kupczyk et al., 2017 Kupczyk P Reich A Hołysz M Gajda M Wysokińska E Kobuszewska A et al. Opioid receptors in psoriatic skin: Relationship with itch. Acta Derm Venereol. 2017; 97: 564-570 Crossref PubMed Scopus (30) Google Scholar ). So far, little is known about the cutaneous expression and function of endogenous opioid peptides and their receptors. This includes the κ-opioidergic system, which is in the current focus of the itch research and already resulted in the first approved peripherally acting KOR agonist difelikefalin. ( Fishbane et al., 2020 Fishbane S Jamal A Munera C Wen W Menzaghi F A Phase 3 Trial of Difelikefalin in Hemodialysis Patients with Pruritus. New England Journal of Medicine. 2020; 382: 222-232 Crossref PubMed Scopus (0) Google Scholar ; Inan et al., 2019 Inan S Huerta A Jensen L Dun N, Cowan A. Nalbuphine, a kappa opiod receptor agonist and mu opioid receptor antagonist attenuates pruritus, decreases IL-31, and increases IL-10 in mice with contact dermatitis. Eur J Pharmacol. 2019; : 864 Google Scholar ) . Interestingly, OPRK1 expression found to be reduced in lesional pruritic skin areas compared to non-lesional, non-pruritic skin areas in patients, with keratinocytes as predominant expression site. Based on these data, itch induced by a cutaneous imbalance in KOR expression with stable expression of MOR has been discussed, forcing the importance of KOR ( Kupczyk et al., 2017 Kupczyk P Reich A Hołysz M Gajda M Wysokińska E Kobuszewska A et al. Opioid receptors in psoriatic skin: Relationship with itch. Acta Derm Venereol. 2017; 97: 564-570 Crossref PubMed Scopus (30) Google Scholar ; Phan et al., 2012 Phan NQ Lotts T Antal A Bernhard JD Ständer S Systemic kappa Opioid receptor agonists in the treatment of chronic pruritus: A literature review. Acta Derm Venereol. 2012; 92: 555-560 Crossref PubMed Scopus (100) Google Scholar ). Therefore, we investigated the KOR, MOR and dynorphin expression in skin biopsies from patients with chronic pruritus-associated inflammatory skin diseases with different pathophysiology and different epidermal pathology. We selected the entities of atopic dermatitis (AD), psoriasis (PSO), chronic nodular prurigo (CNPG), lichen planus (LP), mastocytosis (MAST) and healthy controls.

Экспрессия гена HNP1 у детей с атопическим дерматитом

The expression of innate immune genes, defensins, changes in atopic dermatitis (AD). There has been much research on β-defensins, whereas the role of α-defensins in AD has not been adequately examined. Objective. To evaluate the expression of HNP1 gene in affected and visually unaffected skin areas in patients with different clinical and morphological forms of AD. Patients and methods. The participants in this study (n = 103) were patients admitted to the Maternity and Childhood Center of Sechenov University in 2020–2022. Two skin scraping samples were obtained from each of the patients with AD (n = 89), from skin areas affected and not affected by AD; one skin scraping sample was obtained from control group participants (n = 14) with no skin diseases. To determine the expression of HNP1 in skin cells, a real-time reverse transcription polymerase chain reaction followed by statistical analysis was performed. Results. A significant increase in the expression of HNP1 gene was demonstrated in a more severe course of AD with the development of lichenoid skin changes. The elevated expression level of this antimicrobial peptide indicates the development of inflammatory reactions involving neutrophils in the inflammation area, possibly associated with colonization of the affected skin by opportunistic bacterial pathogens. Conclusion. The α-defensin HNP1 plays an important role in disease progression and can subsequently be used in the treatment of AD as a highly effective alternative approach. Key words: atopic dermatitis, children, neutrophil peptide 1, HNP1

Study of the effectiveness of fractional laser ablation in patients with atrophic postacne scars using the quantitative scar index

Introduction. Atrophic scars are common in acne patients. Regardless of their number and size, they are persistent defects and reduce patients' quality of life. With a variety of treatment options, effective scar correction remains a challenge. Laser technology continues to evolve and is considered promising for the treatment of scars.The aim of the study was to investigate the effectiveness of the fractional laser ablation method in patients with atrophic postacne scars using the quantitative postacne scar index.Materials and methods. The study involved 60 patients with ARP of II-IV severity, 35 women and 25 men. The patients underwent fractional ablation of scars with an Erbium laser (2940 nm). To assess the scars before and after treatment, we used the post-acne scar severity index according to the quantitative assessment scale according to G.J. Goodman et al. Goodman et al. (2006). The international scales Patient's Satisfaction Score, Physician's Satisfaction Score, and Definitive Graduated Score were used to assess physician and patient satisfaction with the results of the procedures.Results. The quantitative index of postacne scars before treatment ranged from 4.0 to 16.0 points and averaged 10.9±3.56 points; median was 12.0 points (8.0±13.0 points). After fractional laser ablation procedures, improvement of quantitative indexes scores (p&lt;0.05), positive dynamics of the doctor's and patients' evaluation of procedure results were noted; no gender differences were noted.Discussion. Quantitative indices of scar expression reflect the severity of the affected skin areas in patients with postacne. This study confirms the effectiveness of fractional ablation with the Erbium laser in patients with ARP, which is confirmed by a decrease in quantitative scar severity indices. Dynamic growth of PSS, PhSS, DGS indices testifies to high satisfaction of the physician and the patient with the results of treatment and correlates with regression of clinical manifestations in these patients.Conclusion. Despite the limitations and laboriousness of counting quantitative indices of postacne scars, this approach allowed to establish and objectify the clinical efficacy of treatment of patients with ARP by fractionated ablation.

Subclinical dermal involvement is detectable by high frequency ultrasound even in patients with limited cutaneous systemic sclerosis

BackgroundThe aim of the study was to detect by skin high-frequency ultrasound (US) possible subclinical skin involvement in patients affected by limited cutaneous systemic sclerosis (lcSSc), in those skin areas apparently not affected by the disease on the basis of a normal modified Rodnan skin score (mRSS). Differences in dermal thickness (DT) in comparison with healthy subjects were investigated.MethodsFifty patients with lcSSc (age 62 ± 13 years (mean ± SD), disease duration 5 ± 5 years) and 50 sex-matched and age-matched healthy subjects (age 62 ± 11 years) were enrolled. DT was evaluated by both mRSS and US at the usual 17 skin areas (zygoma, fingers, dorsum of the hands, forearms, upper arms, chest, abdomen, thighs, lower legs and feet). Non-parametric tests were used for the statistical analysis.ResultsSubclinical dermal involvement was detected by US even in the skin areas in patients with lcSSc, who had a normal local mRSS. In addition, statistically significantly higher mean DT was found in almost all skin areas, when compared to healthy subjects (p < 0.0001 for all areas). In particular, DT was significantly greater in patients with lcSSc than in healthy subjects in four out of six skin areas with a normal mRSS (score = 0) (upper arm, chest and abdomen), despite the clinical classification of lcSSc.ConclusionsThis study strongly suggests that subclinical dermal involvement may be detectable by US even in skin areas with a normal mRSS in patients classified as having lcSSc. This should be taken into account during SSc subset classification in clinical studies/trials.

Expression of protein components desmosomal apparatus and cytoskeleton of the epidermis in disease Hailey-Hailey

Hailey-Hailey disease (benign familial chronic pemphigus Guzhero-Hailey-Hailey) - hereditary vesiculo-bullous dermatosis, where mutation of ATP2C1 gene results in morphological changes, which cause an abnormal location of molecules in intercellular adhesion. It is believed that the pathology may involve both the inner surface of the plasma membrane proteins of keratinocytes and desmosomal and adhesion molecules in epidermal intercellular connections. This present research provides the results of immunohistochemical study on the distribution of desmosomal cadherin (desmogleins 1, 2, 3), desmosomal proteins (plakoglobin, desmoplakin I, periplakin), intercellular junctions molecules (E-cadherin, cadherin complex) in desmosomal apparatus and cytoskeletal proteins (cytokeratins 5, 14, suprabasal layers of epidermis) in clinically intact and affected skin of patients with Hailey-Hailey disease. The research also detected violation in localization of the protein components in the system of intercellular junctions and the cytoskeleton from severe immunohistochemical reaction to disappearance and appearance in places not typical for its localization. Thus, the most severe expression of protein molecules was observed in the areas of acantholysis and the formation of intra-epidermal blisters with the penetration of specific material into the cytoplasm of keratinocytes and some acantholytic cells. Besides, in the clinically intact skin areas of patients the most intense damage (almost complete absence of expression or its “masking”) was identified as a damage with the cadherin adhesion molecules. The paradoxical phenomenon - intranuclear and/or perinuclear luminescence was marked by cytokeratin 5, desmogleins and cadherins. The complex mechanism of Hailey-Hailey disease involving various adhesion molecules and protein components of intercellular connections system requires ongoing detailed study of the expression of multiple adhesion molecules associated with the system of intercellular junctions. The acquired knowledge will bring understanding of the sequence of events in pathology (acantholysis) development and the identification of a number of additional differential diagnostic signs of Hailey-Hailey disease.

Differentially expressed miRNAs in acute wound healing of the skin: a pilot study.

The aim of the present study was to compare expression of microRNAs (miRNAs) from scar and normal skin areas in patients who suffered acute injuries in the skin.A total of 9 patients with acute injuries in the skin who received surgical treatment from December 2012 to March 2013 were included in this pilot study. Specimens from the hypertrophic scar and normal skin areas were obtained from the same patient during surgery. To screen for differentially expressed miRNAs, we applied 3 statistical methods, namely the traditional t test, the false discovery rate (FDR), and a novel sure independence screening procedure based on the distance correlation (DC-SIS). We examined the functional trends and metabolic and regulatory pathways for the target genes of the identified miRNAs, and explored interaction of these miRNAs in the implication of scar healing using Ingenuity Pathway Analysis.DC-SIS identified 18 differentially expressed miRNAs, 4 of which (miR-149, miR-203a, miR-222, miR-122) were also identified by FDR. The target genes of the 4 miRNAs exhibit a variety of biological functions, and are involved in various pathways such as mitogen-activated protein kinase, Wnt signaling, and focal adhesion. We identified 1 network in which 14 out of the 18 differentially expressed miRNAs were involved. Many of the miRNAs in the network target genes were involved in cell proliferation and apoptosis.In this pilot study, we identified several miRNAs exhibiting differential expression in patients who suffered acute injuries in the skin. Further studies on these miRNAs are needed to validate our findings and explore their roles in the wound healing process of the skin.

HLA-DPDQDR is expressed in all lesional skin from patients with autoimmune skin diseases

Introduction: Human genes responsible for human antigen presentation and transplant rejection functions are located on the short arm of Chromosome 6, and are called the Major Histocompatibility Complex (MHC). Moreover, the primary physiologic function of MHC molecules is to present peptides to T lymphocytes. MHC molecules are integral components of the ligands that most T cells recognize, since the T cell receptor (TCR) has specificity for complexes of foreign antigenic peptides, as well as self-MHC molecules. Aim: Our investigation attempts to investigate the presence of HLA-DPDQDR within lesional skin biopsies from patients affected by autoimmune skin blistering diseases (ABDs). Materials and Methods: We utilized immunohistochemistry (IHC) to evaluate the presence of HLA-DPDQDR in lesional skin biopsies of patients affected by ABDs. We tested 30 patients with endemic pemphigus foliaceus (EPF), 15 controls from the EPF endemic area, and 15 biopsies from healthy controls from the USA. We also tested archival biopsies from patients with selected ABDs, including 30 patients with bullous pemphigoid (BP), 20 with pemphigus vulgaris (PV), 8 with pemphigus foliaceus (PF), 14 with dermatitis herpetiformis (DH) and 2 with epidermolysis bullosa acquisita (EBA). Results: Most ABD biopsies stained positive for HLA-DPDQDR in the lesional blisters and/or inflamed neurovascular neuroplexus areas in the superficial dermis, and also at mesenchymal-endothelial like-cell junctions in the dermis. In BP, EBA and EPF, the HLA-DPDQDR staining was also seen in dermal eccrine sweat gland coils and ducts. Conclusion: We document that HLA-DPDQDR is expressed in several anatomic areas of lesional skin in patients with ABDs. Notably, HLADPDQDR positivity was also consistently present in areas of the classic immune response, including epidermal intercellular junctions in pemphigus, and at basement membrane sites in bullous pemphigoid and other subepidermal blistering diseases.

Radiotherapy as a risk factor for malignant melanoma after childhood skin hemangioma

The aim of this study was to determine therapy-related risk factors for the development of melanoma after hemangioma. A cohort study was conducted among 4620 patients treated before 16 years of age for skin hemangioma in France. A nested case-control study was also conducted on 13 patients who developed a melanoma (cases) matched with five controls in cohort according to sex, age at the hemangioma diagnostic, the calendar year of occurrence of the hemangioma, and follow-up. The radiation dose received at the site of the melanoma and at the same site in controls was estimated, and named 'local dose'. A total of 13 melanomas were registered during an average follow-up of overall 35 years, the risk of developing melanoma after a hemangioma treatment was 2.5-fold higher [95% confidence interval (CI): 1.4-4.1] compared with that of the general population, this ratio being only 0.8 (95% CI: 0.05-3.6) in 896 patients who did not receive radiotherapy, but 3.0 (95% CI: 1.6-5.1) after radiotherapy. When adjusting on sex, age, and year of the treatment and follow-up duration, melanoma risk was 11.9 (95% CI: 1.4-123) times higher in patients treated with ytrium 90 than in the ones who did not received radiotherapy. In the case-control study, the risk of melanoma was not linked to the local radiation dose. Indeed, the increase in melanoma risk was observed even for very low local doses. Compared with the corresponding skin areas in patients who did not receive radiotherapy, the ones having received less than 0.001 Gy had a melanoma risk of 3.9 (95% CI: 0.5-32) and those who received more than 0.01 Gy had a risk of 6.9 (0.5-99). This study suggests that radiation therapy of skin hemangioma increases the risk of further melanoma, but we were not able to evidence a relation with the local dose. Nevertheless, childhood treated for hemangioma should be considered at risk for developing melanoma and suspicious pigmented lesions should be carefully evaluated even far from treated areas.

Decreased secretion of MMP by non-lesional late-stage scleroderma fibroblasts after selection via activation of the apoptotic fas-pathway

Our hypothesis is that the development of lesional areas of skin in patients with systemic sclerosis (SSc) originates from the selection of profibrotic cell subpopulations within their non-lesional skin areas, due to their greater resistance to apoptosis. Sensitivity to apoptosis of early-stage or late-stage SSc fibroblasts as well as of healthy cells was compared using extrinsic or intrinsic apoptotic pathway-inducers. Subpopulations of non-lesional SSc cells and healthy cells obtained after repeated Fas-induced apoptosis were compared with respect to their fibrotic parameters such as collagen and MMP secretion. Only late-stage lesional SSc cells were more resistant to Fas-induced apoptosis than their non-lesional counterparts isolated from the same patient. This result correlated with an increase in the levels of the anti-apoptotic proteins cFLIPs and cIAP in lesional cells compared to non-lesional cells. Healthy and non-lesional cell populations could be selected to generate a subpopulation that was more resistant to apoptosis. However, only the late-stage non-lesional SSc fibroblast populations showed a significant decrease in MMP secretion, one of parameters of the fibrosis. Our results show that resistance to apoptosis is an important characteristic of the late-stage lesional SSc fibroblast phenotype. We thus hypothesized that a selection of specific fibroblast subpopulations from late-stage non-lesional SSc skin areas could be at the origin of lesional populations. These cells should become independent of any exogenous stimuli and can induce or maintain SSc skin lesions.

Persistent erythema and edema of the midthird and upper aspect of the face (morbus morbihan): Evidence of hidden immunologic contact urticaria and impaired lymphatic drainage

A persistent erythema and edema of the midthird and upper aspect of the face, which bears some resemblance to Melkersson-Rosenthal syndrome and rosaceous lymphedema, has been characterized as morbus morbihan (MM) by French dermatologists. The disease of yet unknown cause starts with recurrent facial edema of short duration, which ultimately leads to persistent swelling after a period of weeks or months. We recruited 6 patients with MM and acquired their history, routine blood tests, and individual UV light tolerability. To check for contact allergies the allergen patch test and the open epicutaneous patch test were performed. To objectify the skin conditions laser Doppler flowmetry and 20-MHz ultrasound were used. Five patients with similar symptoms, but with definitely transient facial erythema and edema caused by proven contact urticaria on cosmetics served as a comparison group. In all patients, routine blood tests and UVA/UVB light tests showed no pathologic results. Observations of 6 patients with MM revealed the common feature of a clinically relevant immunologic contact urticaria caused by various cosmetic ingredients, which could be diagnosed in all of them. Delayed resorption of the acute edema and prolonged inflammation were shown by laser Doppler flowmetry and 20-MHz ultrasound in the affected skin areas in patients with MM after induction of immunologic contact urticaria by a cosmetic ingredient. Strict avoidance of cosmetics yielded a remarkable clinical benefit in the follow-up examinations. We conclude that recurrent and possibly subclinical inflammation caused by immunologic contact urticaria in conjunction with a locally pre-existing lowered lymphatic drainage plays a crucial role in the evolution of MM.

Lipoxygenase Activity of Pityrosporum In Vitro and In Vivo

Lipid peroxidation has been investigated both in cultures of Pityrosporum supplemented with different lipid classes and in skin surface lipids from patients affected with pityriasis versicolor. Thin-layer chromatography (TLC) and 2 spectrophotometric methods were used: the indirect thiobarbituric acid test and the direct N,N-diethyl-1,4-phenylene-diammonium sulfate (DEPD) test. The coupling of the DEPD test with the TLC technique performed by different eluent systems allowed the detection of the specific lipoperoxides deriving from the oxidation of the different lipid classes. In the cultures, Pityrosporum was capable of peroxidating not only unsaturated free fatty acids, but also unsaturated triglycerides, cholesterol, and squalene. A similar lipid peroxidation was observed in patients with pityriasis versicolor in skin lipids from areas positive for fungal hyphae and spores and fluorescent under the UV lamp (366 nm). The lipoperoxide values were significantly higher (p less than 0.05) than in skin lipids from normal controls. Hyphae and spore-negative areas of patients with pityriasis versicolor, whether apparently normal or achromic, showed no evidence of a significant lipid peroxidation and neither did skin areas of patients with pityriasis alba. Though further investigations are necessary, it seems reasonable to suggest, in analogy with other biologic systems, that the presence in skin lipids of a significant amount of highly reactive and cytotoxic lipoperoxides may play a role in the pathogenesis of skin alterations in pityriasis versicolor, including damage to melanocytes and resulting achromia.