银屑病与代谢综合征发病机制的研究进展

银屑病和代谢综合征是两种临床常见病,可合并出现.银屑病是慢性复发性炎症性多因素皮肤病,发病与遗传、免疫,感染、吸烟以及精神紧张等因素有关.代谢综合征以中心性肥胖为核心,合并高血糖、高血压和脂代谢紊乱等多种代谢异常集结的病理状态.银屑病与代谢综合征发病机制密切相关,且存在共同的细胞因子表达.对代谢综合征的研究可以为银屑病的治疗提供新的靶位.     

银屑病合并代谢综合征的机制

银屑病(psoriasis)是一种免疫介导的慢性复发性炎症性皮肤病,临床上常伴发多种并发症,加大了治疗的难度和风险。近年来多项研究证实,银屑病与代谢综合征的临床指征密切相关,银屑病患者是代谢综合征的高风险人群,代谢综合征又增加了银屑病的复发几率和严重程度。银屑病合并代谢综合征的发病机制涉及遗传学、胰岛素抵抗、氧化应激、内质网应激、炎性因子、脂肪因子、肠道菌群等多种因素,这些因素导致银屑病合并代谢综合征的治疗需区别于常规治疗方案,否则将加剧疾病的发展。本文对银屑病合并代谢综合征的机制进行总结,旨在为相关临床研究和动物实验提供参考。     

银屑病与代谢综合征

目前普遍认为银屑病是在遗传背景控制下,由各种环境因素刺激引起的一种免疫失衡疾病,尽管国内外学者对其发病机制进行了大量研究,至今仍未完全阐明.近年来,银屑病与代谢综合征及其并发症的关系成为研究热点,两者是通过共同的炎症通路相关联还是存在因果关系,以及能否利用此种微妙关系独辟蹊径成为研究银屑病的另一条通路,以期为其治疗提供更多有效手段,但这些尚有待进一步探索.本文对近年来银屑病与代谢综合征的流行病学研究及其可能的发病机制进行综述.     

银屑病与代谢综合征相关性研究进展

近年来流行病学及实验研究发现银屑病不仅是一种慢性炎症性皮肤病,而且是一种系统性疾病,银屑病与肥胖、高血压、高血糖及高脂血症组成的代谢综合征及并发症心血管疾病有关。本文对近年来银屑病和代谢综合征的发病概况、发病机制及二者的相关性等进行了综述。     

银屑病合并症的研究进展

既往认为银屑病是一类慢性炎症性疾病,发病仅表现于皮肤.目前许多的研究证明,在银屑病患者群体中,某些其他疾病的发生率或风险率均较普通人群高,其中包括代谢综合征、肥胖、心血管疾病、关节炎、自身免疫性疾病、恶性肿瘤、精神疾病、肝脏疾病、慢性阻塞性肺部疾病、睡眠呼吸暂停综合征等.通过对这些合并症发病机制的研究,免疫介导的机制似乎是其诸多合并症的共同原因,但要确切了解其发病机制及有效治疗方法,须依靠多学科的有效联合和交叉研究.概述近年来银屑病合并症的流行病学研究及发病机制和治疗方法.     

银屑病与系统性疾病

银屑病是一种常见的慢性、免疫介导的炎症性疾病,重度银屑病患者常伴发一系列的内科疾患,如:代谢综合征、动脉粥样硬化、心肌梗死、恶性肿瘤等.因此,认为银屑病是一种系统性疾病而非单纯的皮肤病.Th1型细胞因子是银屑病与其伴发症的共同免疫基础.为了更有效的治疗银屑病及其伴发症,应提倡综合治疗,需考虑到银屑病与其伴发症在治疗方面的相互影响,另外以潜在炎症基础为治疗靶点的药物可同时治疗银屑病及其伴发症.     

银屑病与胰岛素抵抗关系研究进展

银屑病是一种慢性炎症性皮肤病。近年来,越来越多的证据表明银屑病与代谢综合征的中心环节—胰岛素抵抗之间有显著关联。本文结合国内外文献,从流行病学、病理生理学、分子生物学、基因易感性和临床治疗等方面探讨了银屑病与胰岛素抵抗间的关系,为银屑病发病机制及治疗策略提供新的思路。     

脂肪细胞因子与银屑病

脂肪细胞因子是由脂肪细胞分泌的大量生物活性分子,与代谢综合征(metabolic syndrome,MS)密切相关。银屑病与MS在流行病学、炎症机制甚至易感基因上有着紧密联系。脂肪细胞因子在银屑病发病及治疗过程中含量的变化,提示了银屑病与MS之间存在关联。从脂肪细胞因子入手研究银屑病发病机制、病情发展及其与伴发疾病的关系等,是为治疗银屑病寻找新方法的途径。     

常见脂肪因子与银屑病相关病理机制

银屑病是一种与免疫相关的系统性炎症性皮肤病,近年来发现其与肥胖、高血压、糖尿病、代谢综合征、动脉粥样硬化等代谢性疾病相关。脂肪组织作为内分泌器官,可分泌多种脂肪因子参与炎症和代谢性疾病的发生发展,研究发现脂肪因子可能参与到银屑病的发病过程。本文通过回顾国内外文献,探讨常见脂肪因子与银屑病发病的关系,拟为银屑病提供新的诊疗和研究思路。     

银屑病合并症的研究进展

既往认为银屑病是一类慢性炎症性疾病,发病仅表现于皮肤。目前许多的研究证明,在银屑病患者群体中,某些其他疾病的发生率或风险率均较普通人群高,其中包括代谢综合征、肥胖、心血管疾病、关节炎、自身免疫性疾病、恶性肿瘤、精神疾病、肝脏疾病、慢性阻塞性肺部疾病、睡眠呼吸暂停综合征等。通过对这些合并症发病机制的研究,免疫介导的机制似乎是其诸多合并症的共同原因,但要确切了解其发病机制及有效治疗方法,须依靠多学科的有效联合和交叉研究。概述近年来银屑病合并症的流行病学研究及发病机制和治疗方法。     

Deutliche Einschränkung der Lebensqualität bei Patienten mit Pemphigus vulgaris: Ergebnisse der deutschen Bullous Skin Disease (BSD)‐Studiengruppe

Background: Pemphigus vulgaris is a potentially life‐threatening autoimmune disorder of the skin and mucous membranes characterized by antibodies against epidermal adhesion molecules. Clinically characteristic are painful chronic blisters or erosions of mucous membranes and skin. There are no published studies on the impact o this disease on quality of life. Patients and methods: This registration was performed within the scope of the German BSD (Bullous Skin Disease) study group, from November 1997 until January 2002. A total of 36 patients with the first diagnosis of pemphigus vulgaris were registered at the university hospitals of Dresden, Erlangen, Kiel, Mannheim, München and Würzburg. Thirty of the 36 (83 %) patients participated in the quality of life questionnaire utilizing the German version of ‘Dermatology Life Quality Index’ (DLQI) provided by A. Y. Finlay. The DLQI varies from 0 to 30 with an increased DLQI score indicating a decrease in quality of quality. Results: The overall DLQI total score of 10 ± 6,7 in the investigated pemphigus patients was significantly increased in comparison to other skin diseases. Conclusions: These results suggest that the DLQI can be a very useful additional outcome criteria for clinical studies with pemphigus vulgaris and in the treatment of these patients.     

Mutations in mevalonate pathway genes in patients with familial or sporadic porokeratosis

Porokeratosis comprises heterogeneous keratinization disorders that are characterized by one or more atrophic patches surrounded by a ridge‐like cornoid lamella. In this study, we evaluated seven families affected by porokeratosis and five sporadic patients of the disease in a Chinese population. We performed Sanger sequencing of exons and flanking intron–exon boundaries of mevalonate pathway genes (MVD, MVK, PMVK and FDPS) and of SLC17A9. In five familial and three sporadic patients, we detected six variations, including four novel mutations (MVD c.1A>G; p.Met1?, c.916G>A; p.Ala306Thr, c.1013+1G>A, and PMVK c.65A>G; p.Lys22Arg) and two recurrent mutations (MVD c.746T>C; p.Phe249Ser, and MVK c.1028T>C; p.Leu343Pro). We then applied I‐TASSER and iGEMDOCK to assess these variants for probable functional impacts. The findings of this study extend the mutation spectrum of porokeratosis and provide further evidence for the genetic basis of this disease.     

[Translated article] Pruritus in Dermatology: Part 1—General Concepts and Pruritogens

Pruritus is the most common symptom of dermatologic and systemic diseases. The diagnosis of pruritus is clinical, although additional tests may be necessary to identify or confirm the cause. Translational medicine has led to the discovery of new mediators of itch, or pruritogens, as well as new receptors. Knowing how to properly recognize the main pathway that mediates itch in each patient is the key to successful treatment. Although the histaminergic pathway predominates in conditions like urticaria or drug-induced pruritus, it is the nonhistaminergic pathway that predominates in nearly all other skin diseases covered in this review. Part 1 of this 2-part review discusses the classification of pruritus, additional testing, the pathophysiology of itch and the pruritogens implicated (including cytokines and other molecules), and central sensitization to itch.     

Anästhesieverfahren in der Dermatologie

Zusammenfassung Die Verfahren der Lokalanästhesie sind integraler Bestandteil der operativen Dermatologie. Sie gewährleisten eine effiziente und sichere Analgesie in umschriebenen Haut- und Weichteilregionen und ermöglichen, einen sonst schmerzhaften diagnostischen oder therapeutischen Eingriff bei erhaltenem Bewusstsein zu tolerieren. Einzelne Methoden der Applikation sind "konkurrenzlos", wie die topische Applikation von EMLA^® oder die Kryoanästhesie, andere bieten alternative Optionen zur Allgemeinanästhesie. Die Tumeszenzlokalanästhesie wurde—jenseits der kosmetischen Liposuktion—zu einer effizienten Anästhesieform für größere Operationen bei Tumoren der Haut, plastische Rekonstruktionen und in der Phlebochirurgie weiterentwickelt. Die Wahl des Verfahrens im Einzelfall wird vom Alter, der Kooperationsfähigkeit und der Komorbidität des Patienten bestimmt. Für Infiltrationsanästhesien werden heute vorwiegend Lokalanästhetika vom Amidtyp eingesetzt. Fundierte Kenntnisse über die Anatomie der sensiblen Nerven sind Voraussetzung für erfolgreiche operationsfeldnahe periphere Blockaden. Wenn die Wirkungsweise der Lokalanästhetika, ihre toxischen Effekte und potenzielle Arzneimittelinteraktionen bei ihrem Metabolismus in der Praxis beachtet werden, dann ist das Risiko von Komplikationen relativ gering. Es sollte dennoch nicht unterschätzt, und adäquate Notfallmaßnahmen im Operationsteam sollten regelmäßig trainiert werden.     

Leprosy in a University Hospital in Southern Brazil

BACKGROUND

Leprosy is an infectious disease that may lead to irreversible nerve damage, compromising patient''s quality of life and leading to loss of working years.

OBJECTIVES

To evaluate the epidemiological profile of patients followed at a University Hospital.

MATERIALS AND METHODS

This is a retrospective observational study, based on a review of medical records. We studied the clinical and epidemiological features of patients with leprosy monitored at the Hospital de Clínicas of the Federal University of Paraná between January 2005 and January 2010.

RESULTS

The mean age was 47.51, while 35.94% of patients were aged 41-60. The male:female rate was 1.8:1. The most prevalent occupations were: retired, students or rural workers. Patients came mainly from Curitiba or nearby areas, but there were also patients from the countryside. The mean diagnostic delay was 24.57 months. Multibacillary forms prevailed, with the lepromatous variety being the most common, closely followed by the borderline type. Neural enlargement was found in more than 50% of the patients and 48.44% of them developed reactional states. Hemolysis was the most commonly detected drug side effect. Initial functional evaluation was possible in 70% of patients, 55% of whom had disabilities upon diagnosis. The most prevalent associated disease was hypertension.

CONCLUSIONS

This study showed an important diagnostic delay and a high rate of sequelae in this specific population. Brazil is one of the few remaining countries that has not yet eradicated leprosy and it is important to improve health policies in order to prevent sequelae and achieve eradication.     

Therapie der Akne mit Antiandrogenen – Eine evidenzbasierte Übersicht

Background: Increased sebaceous gland activity with seborrhea is one of the major pathogenetic factors in acne. Antiandrogen treatment targets the androgen‐metabolizing follicular keratinocytes and the sebaceous gland leading to sebostasis, with a reduction of the sebum secretion rate of 12.5 – 65 %. Antiandrogens can be classified based on their mechanism of action as androgen receptor blockers, inhibitors of circulating androgens by affecting ovarian function (oral contraceptives), inhibitors of circulating androgens by affecting the pituitary (gonadotropin‐releasing hormone agonists and dopamine agonists in hyperprolactinemia), inhibitors of adrenal function, and inhibitors of peripheral androgen metabolism (5α‐reductase inhibitors, inhibitors of other enzymes). Methods: All original and review publications on antiandrogen treatment of acne as monotherapy or in combination included in the MedLine system were extracted by using the terms “acne”, “seborrhea”, “polycystic ovary syndrome”, “hyperandrog*”, and “treatment” and classified according to their level of evidence. Results: The combinations of cyproterone acetate (2 mg)/ethinyl estradiol (35 µg), drospirenone (3 mg)/ethinyl estradiol (30 µg), and desogestrel (25 µg)/ethinyl estradiol (40 µg) for 1 week followed by desogestrel (125 µg)/ethinyl estradiol (30 µg) for 2 weeks showed the strongest anti‐acne activity. Gestagens or estrogens as monotherapy, spironolactone, flutamide, gonadotropin‐releasing hormone agonists, and inhibitors of peripheral androgen metabolism cannot be endorsed based on current knowledge. Low dose prednisolone is only effective in late‐onset congenital adrenal hyperplasia and dopamine agonists only in hyperprolactinemia. Treatment with antiandrogens should only be considered if none of the contraindications exist. Conclusion: Antiandrogen treatment should be limited to female patients with additional signs of peripheral hyperandrogenism or hyperandrogenemia. In addition, women with late‐onset or recalcitrant acne who also desire contraception can be treated with antiandrogens as can those being treated with systemic isotretinoin. Antiandrogen treatment is not appropriate primary monotherapy for noninflammatory and mild inflammatory acne.