Reticular erythematous mucinosis and acral papulokeratotic lesions associated with myxoedema due to Hashimoto thyroiditis.

A case is described of a patient with generalized myxoedema due to Hashimoto thyroiditis involving lesions of reticular erythematous mucinosis and acral papulokeratotic lesions with 'church spire' histological pattern. Substitutive treatment with thyroid hormone led to a rapid regression of the cutaneous lesions. The infrequent association of reticular erythematous mucinosis lesions and other forms of cutaneous mucinoses with hypothyroidism is discussed, with special emphasis on the fact that the underlying thyroid disease in all cases was Hashimoto thyroiditis. The association of distal keratotic papules with hypothyroidism has not been previously reported in the literature.     

Refractory pretibial myxoedema with response to intralesional insulin-like growth factor 1 antagonist (octreotide): downregulation of hyaluronic acid production by the lesional fibroblasts

We report a case of refractory pretibial myxoedema (PTM) with Graves' disease in which there was a good clinical response to intralesional injection of the insulin-like growth factor 1 (IGF-1) antagonist octreotide. Intralesional octreotide (200 microg once daily) dramatically improved the tumorous lesions of PTM after 4 weeks, and the lesions remained stable even after reducing the dose to 200 microg once weekly. The amount of hyaluronic acid (HA) in the lesional skin decreased to 5.8 microg mg-1 dry weight from 16.3 microg mg-1 dry weight after 4 weeks of octreotide treatment. IGF-1 showed a dose-dependent stimulatory effect on HA secretion by both normal and patient's fibroblasts at higher concentrations in vitro. Octreotide significantly suppressed IGF-1 induced-HA secretion by the patient's fibroblasts, but not by normal fibroblasts, which suggests that expression of IGF-1 receptor on fibroblasts, or its affinity for IGF-1, are upregulated in PTM, resulting in the oversecretion of HA. These results might suggest that octreotide improves PTM through downregulation of HA production by lesional fibroblasts.     

Investigation of thyroid blood tests and thyroid ultrasound findings of patients with rosacea

We aimed to investigate the relationship between rosacea and thyroid diseases by analyzing thyroid blood tests and ultrasound findings of our patients recently diagnosed with rosacea. This study was designed as a prospective, single‐center study. Dermatological examination findings, lesion locations were recorded, and rosacea clinical scores were calculated for all study group patients. The control group consisted of completely healthy women presented to our hospital during the study period for check‐up purposes. Serum‐free thyroxine, free triiodothyronine, thyroid‐stimulating hormone, antithyroglobulin antibody, antithyroid peroxidase antibody levels were measured, and thyroid ultrasound examinations were performed for all study participants. The entire study cohort consisted of 123 patients (63 cases and 60 controls). There was no significant difference between the groups in terms of mean patient age (P < .05). Cheek was the most common lesion location (96.8%). There was no difference between the groups in terms of thyroid‐related laboratory parameters. However, anti‐TPO levels differed significantly with increasing disease severity (ie, RCSs). There were significant relationships between cheek lesions and fT4 (P = .021), while nose and chin lesions were associated with fT3 (P = .01, P = .001). Thyroid ultrasound findings revealed that rosacea patients tended to have larger thyroid nodules and more heterogeneous thyroid parenchymas than controls. Our findings indicate that thyroid blood tests, including thyroid autoantibodies, should be tested and thyroid ultrasounds should be performed in patients diagnosed with rosacea. However, these findings need to be validated by prospective studies conducted in larger patient series with more extended follow‐up periods.     

Biometrology of physical properties of skin in thyroid dysfunction

Objective There is ample clinical evidence that skin is responsive to physiopathological levels of circulating thyroid hormones. The aim of the study was to assess some physical changes of the skin in the presence of moderate thyroid dysfunction. Setting University Hospital. Patients and methods A total of 119 adults suffering from hypothyroidism or hyperthyroidism and 60 healthy controls were enrolled in this study. Hormonal dosages (TSH, fT3, fT4) were assessed in the serum. A series of biometrological assessments were also performed on the volar and dorsal aspects of the forearms. These included electrometric assessments (Nova Dermal Phase Meter®, Corneometer®), evaporimetry (Tewameter®), colorimetry (Mexameter®), ultrasound shear wave propagation (Reviscometer®) and squamometry X. Correlations were searched between each of the serum hormonal dosages and each of the biometrological parameters. Results The hormonal changes in the untreated patients with thyroid dysfunction were modest in intensity. A few outlier values with regard to the normal range were found for each biometrological parameter. No correlations were found between fT3 or fT4 and each of the physical parameters. By contrast, significant negative linear correlations were found between thyroid‐stimulating hormone (TSH) and skin hydration measured by the Corneometer® and the Nova DPM®. Conclusion This multipronged exploratory study shows that direct or indirect effects of TSH may influence the stratum corneum hydration. This correlation seemed very sensitive, as no other specific biophysical parameter was significantly correlated with the thyroid hormonal concentrations in the serum. However, our findings do not exclude the possibility of some other skin changes supervening in case of more severe thyroid dysfunction. The mechanism by which TSH alters the stratum corneum hydration is yet unknown.     

Evaluation of thyroid function in north Indians with alopecia areata: response to intravenous injection of 100 micrograms thyrotropin releasing hormone (TRH).

There is a lack of agreement on the overall prevalence of thyroid disease and thyroid function abnormalities in alopecia areata. Only one study is available from the Indian subcontinent. All patients with alopecia areata attending a dermatology outpatient clinic between 1983 and 1997 were screened for the presence of clinical thyroid disease. Sixty-two consecutive patients during the year 1994 were evaluated in detail for thyroid functions by measuring T3, T4, TSH levels and testing for antithyroid and antimicrosomal antibodies. Twenty-two patients randomly selected from the above-mentioned sixty two were studied for TSH response to intravenous injection of 100 micrograms TRH at -20, 0 and 20, 60, and 120 minutes after TRH injection. Thyroid disease was clinically evident in 16 (0.85%) of the 1700 patients with alopecia areata seen over the last fifteen years. All sixty-two patients evaluated for thyroid functions were clinically euthyroid. Seven (11.3%) out of these 62 patients had abnormal thyroid hormone levels. Antithyroid and antimicrosomal antibodies were found in five patients; all five had abnormalities in thyroid function. TSH response to TRH was suggestive of hypothyroidism in 4 (18%) of the 22 patients studied. Manifest thyroid disease is infrequently associated with alopecia areata. Abnormalities in thyroid functional status were more frequent; they were found in 7 (11.3%) out of 62 patients. TSH response to intravenous TRH was abnormal in an even higher proportion [4 (18%) out of 22 patients]. There was no apparent correlation with duration or type of alopecia areata.     

Interaction of hairless and thyroid hormone receptor is not involved in the pathogenesis of atrichia with papular lesions

Atrichia with papular lesions (APL) (MIM 209 500) is a rare autosomal recessive disease characterized by early onset of atrichia, followed by a papular eruption within the first years of life. Recent studies demonstrating linkage to chromosome 8p21 and further mutation detection in the hairless gene (HR) have established the molecular basis of APL. This study describes the case of a 16-year-old female with APL due to a missense mutation, D1012N, in the hr-thyroid hormone receptor interacting domain 2 (TRID2) of the HR. Using functional and biochemical analysis, it was determined that this mutation does not significantly affect hr-thyroid hormone receptor interaction. This result suggests that the TRID2 domain either is dispensable in the hr-TR interaction or is not involved in the pathogenesis of APL.     

Mid-dermal elastolysis associated with Hashimoto's thyroiditis

We report the case of a 38-year-old Caucasian female presenting asymptomatic plaques of fine wrinkling and perifollicular papular protrusions especially on the trunk. Histological examination evidenced loss of elastic fibers in the mid-dermis due to elastophagocytosis, with giant cells and granuloma formation. Moreover, elevated titers of thyroid autoantibodies were detected and thyroid ultrasound revealed echo-poor tissue. These findings met the diagnoses of mid-dermal elastolysis and Hashimoto's thyroiditis. This association has not been reported before. We present a comprehensive overview of the literature and discuss the pathogenetic aspects of mid-dermal elastolysis and the significance of the association with Hashimoto's thyroiditis.     

The hairless promoter is differentially regulated by thyroid hormone in keratinocytes and neuroblastoma cells

The hair cycle is an extraordinarily complex process relying on spatially and temporally coordinated integration of intercellular signaling, cell division and death, cell migration, and gene expression. The hairless gene (hr) is expressed with hair-cycle-dependent kinetics, and pathogenic mutations in hr are responsible for the hairless and rhino phenotypes in mice and atrichia with papular lesions in humans. In addition to its expression in the skin and hair follicle, hr is also highly expressed in the brain, yet the factors governing its differential cell-type-specific expression have not yet been defined. A thyroid hormone responsive element was previously identified in the rat hr promoter which confers thyroid hormone (T3) responsiveness to heterologous promoter constructs; however, prior studies have not focused on the hr promoter itself. The hairless promoter was cloned, and it is shown that the hr promoter is transactivated by T3 in neuroblastoma cells but not in keratinocytes. Therefore, while T3 has a significant role in the regulation of neuronal expression of hairless, its upregulation in keratinocytes is T3 independent. Furthermore, hr is subject to cell-type-specific negative autoregulation, inhibiting the activity of its own promoter in keratinocytes but not neuroblastoma cells. These findings illustrate a molecular distinction between the regulation of hr expression in defined cell populations.     

慢性荨麻疹伴甲状腺疾病的诊治方法探讨

目的探讨总结慢性荨麻疹伴自身免疫性甲状腺疾病的诊治方法。方法对我院2000年~2004年收治的8例确诊为慢性荨麻疹伴甲状腺自身免疫性疾病的临床资料进行回顾性分析。结果8例中,7例的FT3(25.81±3.50)pmol/L,FT4(60.56±6.20)pmol/L,均明显高于正常值,uTSH(0.116±0.012)m IU/L明显低于正常值,给予抗甲亢、手术和抗组胺等同时治疗后,荨麻疹与甲亢症状消失。结论对于原因不明的慢性荨麻疹患者,应作甲状腺功能检查。若伴甲状腺疾病者应同时给予抗组胺并针对甲状腺疾病进行治疗。     

Regulation of epidermal keratin expression by retinoic acid and thyroid hormone.

In the epidermis, retinoic acid (RA) is known to regulate the gene expression of keratins, the intermediate filament proteins of epithelial cells. We have cloned the upstream regulatory regions of three human epidermal keratin genes, K5, K10, and K14, and engineered DNA constructs in which these regions drive expression of the CAT reporter gene. By co-transfecting the constructs into various epithelial cell types along with the vectors expressing the nuclear receptors for RA and thyroid hormone (T3), we have shown that RA and T3 directly regulate expression of these three keratin genes through the action of their nuclear receptors. In this paper, we review our previous results to stress that RA has a dual effect on keratin expression in epidermis: both direct and indirect. We also analyze the DNA sequences upstream from those three RA-regulated keratin genes and identify the clusters of degenerate consensus half-site motifs, which may comprise the putative retinoic acid recognition elements (RAREs). Furthermore, our recent results concerning the regulation of K5 and K14 expression by the RA receptor are also shown; these confirm our predictions regarding the location of the RAREs in epidermal keratin genes.     

Are melanocortin peptides future therapeutics for cutaneous wound healing?

Cutaneous wound healing is a complex process divided into different phases, that is an inflammatory, proliferative and remodelling phase. During these phases, a variety of resident skin cell types but also cells of the immune system orchestrate the healing process. In the last year, it has been shown that the majority of cutaneous cell types express the melanocortin 1 receptor (MC1R) that binds α‐melanocyte‐stimulating hormone (α‐MSH) with high affinity and elicits pleiotropic biological effects, for example modulation of inflammation and immune responses, cytoprotection, antioxidative defense and collagen turnover. Truncated α‐MSH peptides such as Lys‐Pro‐Val (KPV) as well as derivatives like Lys‐d ‐Pro‐Thr (KdPT), the latter containing the amino acid sequence 193‐195 of interleukin‐1β, have been found to possess anti‐inflammatory effects but to lack the pigment‐inducing activity of α‐MSH. We propose here that such peptides are promising future candidates for the treatment of cutaneous wounds and skin ulcers. Experimental approaches in silico, in vitro, ex vivo and in animal models are outlined. This is followed by an unbiased discussion of the pro and contra arguments of such peptides as future candidates for the therapeutic management of cutaneous wounds and a review of the so‐far available data on melanocortin peptides and derivatives in wound healing.     

Altered sperm function or sperm antibodies are not associated with chlamydial antibodies in infertile men with leucocytospermia

OBJECTIVE: Leucocytospermia, defined as a concentration of more than 10(6) leucocytes/ml of seminal fluid in patients without clinical symptoms due to an adnexitis, is seen in about 10% of patients in an infertility department. Infection with Chlamydia trachomatis is possibly relevant as other pathogenic bacteria were not cultured from the semen in significant numbers. SETTING: University Clinic, Department of Andrology. PATIENTS: Two hundred and seven patients attending the department for male infertility investigation. METHODS: Analysis on each semen sample included determination of leucocyte count and the MAR test for the detection of sperm antibodies. Chlamydial antibodies in semen were determined using an on-slide enzyme immunoassay. RESULTS: No differences between leucocyte counts in patients with and without chlamydial antibodies were detected. In addition, no differences in the sperm parameters or results of MAR-tests in these two groups was seen. There were no correlations between the leucocyte count and sperm parameters, including the MAR-test results. CONCLUSIONS: We conclude that antibodies to chlamydiae in semen are not associated with leucocytospermia. Leucocytospermia per se does not appear to be significant for the sperm functions and immune responses to sperm.     

Thyroid dysfunction in patients with psoriasis: Higher prevalence of thyroid dysfunction in patients with generalized pustular psoriasis

The association of psoriasis with thyroid dysfunction has been investigated; however, it remains controversial. Some papers indicate it, and others do not. Thereby, we investigated the prevalence of thyroid dysfunction in patients with psoriasis vulgaris (PsV), psoriatic arthritis (PsA) and generalized pustular psoriasis (GPP), and the relationship between the severity of psoriasis with serum free triiodothyronine (fT3), free thyroxine (fT4) and thyroid-stimulating hormone levels. Data on 85 psoriatic patients visiting our hospital from January 2015 to November 2017 (54 men and 31 women; 51 PsV, 23 PsA 23 and 11 GPP) were retrospectively analyzed. Fourteen percent of psoriatic patients had thyroid dysfunction. The percentage of patients with thyroid dysfunction was the highest in those with GPP (45% GPP, 13% PsA, 8% PsV). Patients with thyroid dysfunction demonstrated significantly higher Psoriasis Area and Severity Index scores and elevated serum C-reactive protein (CRP) levels than those without thyroid dysfunction. A significant negative correlation was observed between the serum levels of CRP and fT3 (P = 0.0032, r = −0.4635). Our data indicate that thyroid dysfunction in patients with psoriasis is associated with inflammation caused by psoriasis.     

Epidermal programmed cell death‐ligand 1 expression in TEN associated with nivolumab therapy

Nivolumab is a programmed cell death receptor‐1 (PD‐1) antibody used in the treatment of metastatic or unresectable melanoma. Cutaneous reactions are the most common adverse events reported with these agents and are rarely severe or life‐threatening. Here we present a case report describing the clinicopathological findings of a patient with a fatal toxic epidermal necrolysis (TEN) eruption associated with use of nivolumab for treatment of metastatic melanoma. The patient developed a pruritic, morbiliform eruption, which slowly progressed over 3 months to a tender, exfoliative dermatosis. Histology initially showed interface dermatitis and subsequently revealed full thickness epidermal necrosis. The diagnosis of TEN was made. From initial biopsy to TEN presentation, there was an increase in the number of CD8+ lymphocytes within the dermal–epidermal junction and an increase of programmed death ligand 1 (PD‐L1) expression in both lymphocytes and keratinocytes. Despite treatment with infliximab, high‐dose steroids and intravenous immunoglobulin, the patient expired. Herein we describe what we believe is the second case of TEN associated with anti‐PD1 therapy reported in the literature. Increased expression of PD‐L1 by immunohistochemistry was observed as the eruption progressed to TEN. Early diagnosis and treatment is necessary in these fatal TEN reactions secondary to the anti‐PD‐1 antibody therapies.     

马拉色菌相关婴儿皮肤病

马拉色菌是人皮肤表面的常驻真菌，能引起婴儿花斑癣，并与婴儿脂溢性皮炎、婴儿特应性皮炎、新生儿头部脓疱病、婴儿及新生儿痤疮的发病相关。这种相关性主要表现在皮损处能检出马拉色菌，且抗真菌治疗有效，在婴儿特应性皮炎的发病中，主要作为抗原。由于婴儿和新生儿的皮肤屏障功能、机体免疫功能等尚不成熟，在患该类疾病时临床表现不典型，较成人有差异，治疗以外用药物为主。     

白癜风患者215例临床分析

目的：总结白癜风患者的临床特点和发病诱因.方法：对确诊的白癜风患者进行问卷设计和调查,用SPSS 11.5软件包进行统计分析.结果：资料完整的215例白癜风患者中男98例,女117例;平均发病年龄18.76±7.43岁;最常见的受累部位为上肢（54.42%）;伴发疾病中以甲状腺疾病最常见（5.58%）;有家族史者占13.02%,有家族史患者发病年龄为14.6±4.31岁,无家族史为25.09±5.45岁（P〈0.001）,两者间有显著性差异;春夏季发病最常见;25.58%的患者可发现诱因,其中常见的诱因包括精神因素 （43.64%）和皮肤损伤（56.36%）.结论：本地区白癜风好发于青少年,有家族史患者发病年龄早于无家族史患者,上肢为最常见的好发部位,可能与精神因素和皮肤外伤、日晒伤有关.     

Q开关红宝石激光联合氨甲环酸治疗黄褐斑的疗效评价及对黑素代谢的作用

目的 观察Q开关红宝石激光联合氨甲环酸治疗黄褐斑的疗效及对黑素代谢的作用.方法 将60例黄褐斑患者随机分为3组:药物组(口服氨甲环酸500 mg/d,疗程6个月)、激光组(Q开关红宝石激光,每2周1次,疗程2个月)、联合组(激光联合氨甲环酸,方法及疗程同其他两组),比较治疗后三组黄褐斑面积及严重程度评分(MASI)、疗...