Clinico-immunologic characteristics and prevention of occupational allergic dermatoses due to molybdenum exposure

Occupational diseases of the skin have been detected in 19.6% of 352 workers engaged in molybdenum production. These diseases are characterized by a relatively low incidence on the dermatitis transformation into eczema and a considerable length of this process, by weak skin reactions to molybdenum tests (with 20% aqueous solution of ammonium paramolybdate), by the predominance of skin itching in the clinical picture, by a secondary pyococcic infection, and by frequent combination of eczema with allergic involvement of the ENT organs. Experimental and clinical immunologic studies have revealed that mostly humoral immune mechanisms with a relatively weak involvement of the T-lymphocytes contribute to the pathogenesis of the dermatoses due to molybdenum exposure; this fact is responsible for poor clinical manifestation of the delayed type hypersensitivity reactions and at the same time a manifest IgE-dependent pattern of allergic reactions. A clear-cut correlation between the frequency of the dermatoses and molybdenum level in environmental dust was detected, as were a considerable molybdenum contamination of the skin and the fact that hot and humid microclimate are conducive to the development of dermatoses. Basing on the results of these studies, the authors have developed recommendations on the diagnosis and prevention of molybdenum-induced dermatoses.     

THE DERMATOSES OF PREGNANCY

The skin changes in pregnancy can be either physiological (hormonal), changes in pre-existing skin diseases or development of new pregnancy specific dermatoses. Pregnancy-specific skin dermatoses include an ill-defined heterogeneous group of pruritic skin eruptions which are seen only in pregnancy. These include atopic eruption of pregnancy, polymorphic eruption of pregnancy, pemphigoid gestationis and intrahepatic cholestasis of pregnancy. Atopic eruption of pregnancy is the most common of these disorders. Most skin eruptions resolve postpartum and require only symptomatic treatment. Antepartum surveillance is recommended for patients with pemphigoid gestationis and intrahepatic cholestasis of pregnancy as they carry fetal risk. This article deals with the classification, clinical features and treatment of the specific dermatoses of pregnancy.     

Spezifische Schwangerschaftsdermatosen

The specific dermatoses of pregnancy represent a heterogeneous group of inflammatory skin diseases related to pregnancy and/or the postpartum period. The most recent classification includes pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. The hallmark of all four entities is severe pruritus that is accompanied by characteristic skin changes. While some of these dermatoses are distressing only to the mother because of pruritus, others may be associated with significant fetal risks. Early diagnosis and prompt treatment are therefore essential. In this review, we will discuss the various pregnancy dermatoses in detail and present an algorithm for diagnosis and management of pruritus in pregnancy.     

Ecologic perspective of dermatologic problems in North Eastern India

In the nations of the developing world, the incidence of skin diseases is especially affected by geography. Epidemiological studies of skin diseases are important in the study of disease pattern, changes in disease pattern and for planning dermatology service and research for a country. This report records the pattern of skin diseases encountered in the North-East region of India. The incidence of non-infectious dermatoses was slightly higher than that of infectious dermatoses in this part of the country.     

The skin in primary immunodeficiency disorders

Primary immunodeficiency disorders comprise serious and rare diseases, predominantly in children. The skin may be involved in a primary immunodeficiency and the cutaneous alterations such as infections, eczematous dermatitis, erythroderma, autoimmune dermatoses and vasculitis may be the basis for the ultimate diagnosis. Dermatologists may realize something is wrong with the immunity of their patient and prompt diagnosis of the defect can lead to lifesaving treatment. Since atypical presentations of well known dermatoses are common in immunodeficiency disorders, histopathology and bacterial, fungal or viral tests of the skin lesions are often indispensable. The knowledge of skin findings in primary immunodeficiency diseases may help dermatologists to play a role in the early detection of these diseases. Key findings constitute specific skin symptoms combined with unusual or severe infections.     

Common dermatoses in moderately pigmented skin: uncommon presentations

Several common dermatoses appear different in people of color. Most international literature, especially the reputed textbooks, are replete with photographs of skin diseases in fair-skinned patients. The orientation of Western dermatologists to common diseases in pigmented skin therefore is needed. The reverse is also true. Dermatologists who work in pigmented skin communities are known to have initial problems with fair skin. It is therefore important to have a judicious balance of entities seen in both of these skin types in major international literature, especially in textbooks. In addition, common dermatoses may appear strange and confusing particularly when they are in their advanced form. People with pigmented skin living in developing countries often present with diseases that appear greatly altered, because of various reasons. Main ones are treatment taken at home with household remedies, especially topical therapy, inappropriate treatment given by general practitioners with sparse knowledge of dermatology, and injudicious steroid use. All these factors lead to exacerbation of the disease or superimposed irritation or infection, which all contribute to a different appearance. Equally important is the delay in seeking treatment because of financial constraints.     

Prevalences of and risk factors for vulvar diseases in Nepal: a hospital-based study

Background The vulvar diseases are common skin conditions, but their frequency and importance are often underestimated. Objectives This study is aimed to investigate the frequency and clinical patterns of vulvar diseases and the risk factors associated with these diseases in patients attending a tertiary care hospital in eastern Nepal. Methods Patients with vulval symptoms or cutaneous lesions on the vulva were enrolled in the study. Laboratory investigations were carried out according to need. Equal numbers of age‐matched females without vulval lesions or symptoms were selected from the outpatient department as controls. Results Of 5521 female patients attending the Dermatology Department’s outpatient clinic during the study period, 105 (1.9%) had vulval symptoms and/or lesions. The most common types of vulvar disease were vulvar dermatoses (62.85%), pruritus vulvae (36.19%) and vulvodynia (0.95%). In vulvar dermatoses, infection was the most common (33.4%) manifestation, with a predominance of vulvovaginal candidiasis. Other dermatoses included: cysts and tumors (5.6%); pigmentary changes (vitiligo) (5.6%); inflammatory dermatoses (6.6%); atrophic vaginitis (1.8%); erosive disease (0.9%); and dermatosis caused by sexual abuse (1.9%). Use of nylon undergarments, occasional detergent use for washing clothes, and an irregular menstrual history were found to be associated with vulvar diseases. Conclusions Our study findings indicate that the known frequency of vulvar diseases may represent only a small proportion of actual frequency. Further clinical and population‐based research should be carried out with respect to the treatment, follow‐up, and true prevalence of these diseases in the community.     

Distribution and arrangement of multiple lesions in the anogenital region

A series of skin diseases may affect the anogenital region with unusual presentations; therefore, a careful clinical approach is needed to make a correct diagnosis. Diseases of the anogenital area include inflammatory dermatoses, infectious lesions, and neoplastic conditions. Inflammatory dermatoses are frequently not restricted to the anogenital area and often occur on other sites. Infectious anogenital lesions can be easily confused with other benign or malignant processes. Tumors that arise on the anogenital skin are similar to those that occur on the skin elsewhere. The differential diagnosis of all of these lesions often depends upon the distribution and arrangement of the skin lesions.     

自身免疫性大疱性皮肤病细胞免疫机制进展

自身免疫性大疱性皮肤病是一类以皮肤、黏膜红斑和水疱为主要临床表现的皮肤病.体液免疫与细胞免疫均参与发病机制中.其中细胞免疫表现为初始T细胞通过T细胞受体与抗原特异结合后,在一些辅助因素作用下,活化、增殖并分化为效应T细胞,这些细胞表面相关细胞因子通过与B细胞表面相关受体结合,从而激发B细胞产生浆细胞及记忆细胞,进而分化为高亲和力抗体,产生免疫应答.而这些起辅助作用的细胞因子主要有辅助性T细胞、调节性T细胞等相关的细胞因子,这些细胞因子的研究对寻求自身免疫性大疱病的根源及靶向治疗意义重大.     

Obesity and the skin: skin physiology and skin manifestations of obesity

Obesity is widely recognized as an epidemic in the Western world; however, the impact of obesity on the skin has received minimal attention. The purpose of this article is to highlight the association between obesity and dermatologic conditions. We review the impact of obesity on the skin, including skin physiology, skin manifestations of obesity, and dermatologic diseases aggravated by obesity. Obesity is responsible for changes in skin barrier function, sebaceous glands and sebum production, sweat glands, lymphatics, collagen structure and function, wound healing, microcirculation and macrocirculation, and subcutaneous fat. Moreover, obesity is implicated in a wide spectrum of dermatologic diseases, including acanthosis nigricans, acrochordons, keratosis pilaris, hyperandrogenism and hirsutism, striae distensae, adiposis dolorosa, and fat redistribution, lymphedema, chronic venous insufficiency, plantar hyperkeratosis, cellulitis, skin infections, hidradenitis suppurativa, psoriasis, insulin resistance syndrome, and tophaceous gout. We review the clinical features, evidence for association with obesity, and management of these various dermatoses and highlight the profound impact of obesity in clinical dermatology. LEARNING OBJECTIVE: After completing this learning activity, participants should be aware of obesity-associated changes in skin physiology, skin manifestations of obesity, and dermatologic diseases aggravated by obesity, and be able to formulate a pathophysiology-based treatment strategy for obesity-associated dermatoses.     

Histopathologic pattern analysis of human intracutaneous tuberculin reaction

The involvement of cellular immune reactions in the pathogenesis of many inflammatory dermatoses can be postulated from their histopathologic features, e.g., those dermatoses that show a perivascular lymphohistiocytic infiltration in the dermis in addition to their own characteristic epidermal changes. Several granulomatous dermatoses further show an additional infiltration of epithelioid cells. However, experimental production of similar changes is usually not feasible in animals. A human model is needed of delayed-hypersensitivity skin reaction induced by a definite antigen. After closely observing the histopathologic changes of the skin reactions to the purified protein derivative (PPD) of tuberculin, we noted that all patients did not show uniform histologic patterns at intradermal PPD injection sites. Therefore, we have tentatively analyzed histopathologically the pattern of tuberculin skin reactions at injection sites 48 h to 1 year after injection in eight healthy volunteers and 63 patients with various dermatoses. We classified the reactions at 48 h into three types, based on the extent of the tissue damage (i.e., their resemblance to features noted in corresponding inflammatory dermatoses): (a) the perivascular dermatitis type, (b) the basal spongiotic dermatitis type, and (c) the erythema multiforme type. There was a clear correlation between the magnitude of macroscopic skin reactions and these histopathologic patterns. Even those with clinically negative reactions showed a reaction pattern of perivascular dermatitis, whereas those who clinically developed prominent inflammatory reactions with blister formation always showed a erythema multiforme-like histologic pattern. Interestingly, in more than half of the cases, the dermal cellular infiltrate had a mixture of various numbers of neutrophils in addition to mononuclear cells.(ABSTRACT TRUNCATED AT 250 WORDS)     

Animal models for autoimmune bullous dermatoses

Abstract:  Autoimmune bullous dermatoses are a group of severe diseases, which are clinically characterized by blisters and erosions of skin and/or mucous membranes. In order to investigate the pathogenesis of these potentially life-threatening diseases and to develop more specific therapeutic approaches, animal models have been developed that aim to reproduce the clinical, histological and immunopathological findings. We here review established and novel animal models of autoimmune skin blistering diseases and discuss their applications and limitations.     

Autoimmune bullous diseases in pregnancy: clinical and epidemiological characteristics and therapeutic approach

Autoimmune bullous dermatoses are a heterogeneous group of diseases with autoantibodies against structural skin proteins. Although the occurrence of autoimmune bullous dermatoses during pregnancy is low, this topic deserves attention, since the immunological and hormonal alterations that occur during this period can produce alterations during the expected course of these dermatoses. The authors review the several aspects of autoimmune bullous dermatoses that affect pregnant women, including the therapeutic approach during pregnancy and breastfeeding. Gestational pemphigoid, a pregnancy-specific bullous disease, was not studied in this review.     

Paraneoplastic cutaneous manifestations: concepts and updates

The skin often signals systemic changes. Some neoplastic diseases that affect internal organs may trigger several cutaneous manifestations. Although these dermatoses are relatively unusual, the recognition of some typical paraneoplastic dermatoses may lead to the early diagnosis of a neoplasm and determine a better prognosis. In this review article, we discuss the paraneoplastic cutaneous manifestations strongly associated with neoplasms, which include acanthosis nigricans maligna, tripe palms, erythema gyratum repens, Bazex syndrome, acquired hypertrichosis lanuginosa, necrolytic migratory erythema, Leser-Trélat sign and paraneoplastic pemphigus. We also review the clinical manifestations of each condition and include updated knowledge on disease pathogenesis.     

microRNA与皮肤病研究进展

miRNA(microRNA)是一类非编码RNA,长度通常为21 ～ 25个核苷酸。通过和靶mRNA的互补结合抑制蛋白表达,对机体进行多方面的调控。miRNA在多种疾病中的调控作用已得到证实,目前研究表明,miRNA和某些皮肤疾病存在一定的相关性,并在皮肤中的表达具有特征性,可以在不同种属、不同组织及不同疾病中发挥调节作用。进一步研究miRNA与皮肤疾病之间的关系也为疾病的治疗提供了新的思路及新的靶点。     

Lichen striatus and blaschkitis: reappraisal of the concept of blaschkolinear dermatoses

Background Blaschkitis (BL) and lichen striatus (LS) are rare dermatoses occurring along the Blaschko lines of the skin with preferential occurrence in distinct age categories. Controversy exists regarding the pathogenesis and classification of BL and LS within the spectrum of blaschkolinear dermatoses. Objectives To describe the clinicopathological characteristics of six cases of BL/LS with special emphasis on immunophenotyping the inflammatory infiltrate. Additionally, we review and critically discuss current concepts of the blaschkolinear dermatoses. Methods Skin biopsies from six patients with BL and LS were analysed retrospectively. The immunophenotypes of the inflammatory cells were determined and related to clinical features. Results The clinical characteristics of the diseases occurred equally in both genders and all ages. BL and LS had similar histopathological findings with respect to epidermal changes and composition of the inflammatory infiltrates. Characteristically, a lichenoid lymphocytic infiltrate with exocytosis of inflammatory cells and obvious alterations of the interface zone was observed. Conclusions We characterize the two main blaschkolinear dermatoses BL and LS sensu stricto morphologically and open new insights into the pathogenesis of these diseases. We propose the concept of a wide spectrum of blaschkolinear dermatoses with BL and LS located somewhere within the spectrum. We do not think that it is helpful for clinicians to enlarge the spectrum of blaschkolinear diseases and to create numerous ‘new’ entities. Rather, our aim was to unify diseases with similar clinical and histopathological features and common genetic pathomechanisms underlying phenotypic variations.     

The structure of skin pathology in middle-aged and elderly subjects

The prevalence of skin diseases in elderly and senile patients was analyzed basing on the consultation rate records. Allergic and itching dermatoses (dermatitis, eczema, neurodermatitis, urticaria, skin itching, prurigo) rank first in this patient population; their share in the total incidence of skin diseases has made up 49.4%. These data call for thorough studies of this group of dermatoses in elderly and senile patients.     

Aquatic sports dermatoses: part 1. In the water: freshwater dermatoses

The first of this three-part series on water-related dermatoses involving the athlete will include sports occurring with the majority of time spent in the water. These sports include swimming, diving, scuba, snorkeling and water polo. Numerous authors have described dermatologic conditions commonly seen in swimmers. This series provides an updated and comprehensive review of these water dermatoses. In order to organize the vast number of skin conditions related to water exposure, we divided the skin conditions into groupings of infectious and organism-related dermatoses, irritant and allergic dermatoses and miscellaneous dermatoses. The vast majority of skin conditions involving the water athlete result from chemicals and microbes inhabiting each environment. When considering the effects of swimming on one's skin, it is also useful to differentiate between exposure to freshwater (lakes, ponds and swimming pools) and exposure to saltwater. This review will serve as a guide for dermatologists, sports medicine physicians and other medical practitioners in recognition and treatment of these conditions.     

Aquatic sports dermatoses: Part 3. On the water

The third of this three-part series on water-related sports dermatoses discusses skin changes seen in athletes who participate in sporting activities on top of or nearby water. While also susceptible to several of the freshwater and saltwater dermatoses discussed in parts one and two of the series, these athletes may present with skin changes unique to their particular sports. This updated and comprehensive review details those near-water dermatologic conditions commonly seen in sailors, rowers, fishermen, surfers, windsurfers, rafters, and water skiers, and will serve as a guide for dermatologists, sports medicine physicians and other medical practitioners in recognition and treatment of these conditions.     

The environment‐pathogen‐host axis in communicable and non‐communicable diseases: Recent advances in experimental and clinical research

Allergies and autoimmune diseases are spreading worldwide. Control of infections, on the other hand, remains an issue, even in the post‐antibiotic era. Chronic or poorly controlled infections occur in immune compromised individuals such as HIV patients, hospitalized patients exposed to multi‐resistant bacteria, or patients on immunosuppressive treatment. They may become an even more emerging issue in an ageing population. At the same time, profound environmental changes such as global warming, urbanization, increasing environmental pollution and novel food engineering technologies may alter the abundance or aggressiveness of allergens/allergen carriers in our environment. Likewise, changes in dietary habits – and possibly also use of antibiotics – have an impact on the composition of our natural microbial flora in the gut, airways and skin, which may alter susceptibility for common diseases, among them allergies, asthma and atopic eczema. At the recently founded Institute of Environmental Medicine of the Technische Universität Munich, located in Augsburg at the UNIKA‐T, experimental, clinical and translational research is focused on the complex interactions of environment, pathogen and host in expression or control of communicable and non‐communicable diseases. We present our research concept and recent findings in environment – host interactions.