The natural phytochemical trans‐communic acid inhibits cellular senescence and pigmentation through FoxO3a activation

Ageing is characterized by the accumulation of chronic and irreversible oxidative damage, chronic inflammation and organ dysfunction. To attenuate these ageing‐related changes, various natural phytochemicals are often applied. Trans‐communic acid (TCA), an active component of brown pine leaf extract, has antimicrobial and cancer chemopreventive activity and inhibits ultraviolet B (UVB)‐induced MMP‐1 expression. To determine whether the phytochemical TCA could affect the lifespan of an ageing model, Caenorhabditis elegans prevent ageing‐related phenotypes of the skin. Caenorhabditis elegans (C. elegans) wild‐type N2 and mutant strains were used in this study to explore the lifespan extension effect of TCA and its mechanism. We estimated lipofuscin accumulation and melanin levels, which are closely associated with skin senescence. Moreover, we explored the mechanism of action associated with ageing attenuation. We performed oxidative stress resistance and thermotolerance assays in C. elegans and surface plasmon resonance analysis of TCA binding with the forkhead box‐O3a (FoxO3a) protein. TCA, which is the active component in Korean red pine (Pinus densiflora), attenuated ageing‐related changes in skin cells. TCA lowered lipofuscin accumulation in fibroblasts and decreased melanin levels in melanocytes. These protective effects were mediated by activation of the representative longevity gene FoxO3a, which was induced by direct binding with TCA. Interestingly, TCA extended the lifespan of C. elegans, although it did not affect stress resistance, oxidative stress or thermotolerance. These results strongly suggest that TCA prevents the senescent phenotype of model organisms and exhibits beneficial effects on ageing‐related skin phenotypes through direct FoxO3a activation.     

Is there any relation between serum insulin and insulin‐like growth factor‐I in non‐diabetic patients with skin tag?

Background Skin tags are common benign lesion occurring mainly on the neck and major flexures as a small soft pedunculated protrusion. This study evaluate insulin and insulin‐like growth factor‐I (IGF‐I) in non‐diabetic ones. Methods and materials A case–control study was conducted in non‐diabetic persons. Comparing insulin and IGF‐I between matched cases (n = 40) and controls (n = 40) by radioimmunoassay test. Cases and controls were recruited from patients consecutively seen at an academic outpatient dermatology clinic. Results The insulin level in patients with skin tags was significantly higher than controls (P = 0.00) but IGF‐I level was not significantly different (P = 0.43). Conclusion These results show an increased insulin level in non‐diabetics ones and overall importance of insulin effect in pathogenesis of skin tags.     

Peripheral insulin resistance in patients with Behçet''s disease

In this study, we examined peripheral insulin resistance in patients with Behçet's disease (BD) characterized by chronic inflammation and endothelial dysfunction. Fourteen patients with BD and 15 healthy controls were recruited to the study. Insulin resistance was investigated by the hyperinsulinaemic–euglycaemic glucose clamp technique. BD patients displayed an enhanced rate of insulin resistance compared to healthy controls (P = 0.014). The insulin sensitivity (M), measured as the glucose utilization rate under steady‐state conditions of euglycaemia, was significantly decreased (P = 0.001) in BD patients compared to the controls (4.09 ± 0.16 vs. 5.60 ± 0.27 mg/kg/min). The C‐reactive protein (CRP) level, but not the erythrocyte sedimentation rate (ESR), was significantly related to the presence of insulin resistance (CRP: r_s = 0.589, P = 0.27; ESR: r_s = 0444, P = 0112), whereas no relationship was found between the M‐value and ESR or CRP. We conclude that patients with BD exhibit peripheral insulin resistance; this could be explained as the diverse consequences of inflammation and endothelial dysfunction in BD.     

Short‐term isotretinoin treatment decreases insulin‐like growth factor‐1 and insulin‐like growth factor binding protein‐3 levels: does isotretinoin affect growth hormone physiology?

Summary Background Isotretinoin is an effective treatment for acne vulgaris. However, it has numerous side‐effects. It was previously reported that serum growth hormone (GH) levels decreased with isotretinoin treament. Objectives To analyse whether isotretinoin has any effects on insulin‐like growth factor‐1 (IGF‐1), insulin‐like growth factor binding protein‐3 (IGFBP3) and GH levels. Methods Forty‐seven patients aged 21·5 ± 5·1 years (mean ± SD) with acne vulgaris were included in this study. Isotretinoin therapy was initiated at a dose of 0·5–0·75 mg kg^?1 daily and then adjusted to 0·88 mg kg^?1 daily as maintenance dosage after 1 month. Screening for biochemical and hormonal parameters was performed just before initiation and after 3 months of isotretinoin treatment. Results IGF‐1 and IGFBP3 levels decreased significantly after treatment (P < 0·01), while GH levels did not change. Post‐treatment, significant increases were seen in aspartate aminotransferase, total cholesterol, low‐density lipoprotein cholesterol, triglycerides and low‐density lipoprotein cholesterol/high‐density lipoprotein cholesterol ratio (P < 0·0001) while high‐density lipoprotein cholesterol levels were significantly decreased (P < 0·0001). Conclusions Isotretinoin therapy may have an effect on GH physiology, and further studies are needed to understand this association.     

Metformin as an adjunct therapy for the treatment of moderate to severe acne vulgaris: A randomized open‐labeled study

Insulin, insulin‐like growth factor‐1 (IGF‐1) and essential amino acids activate the mechanistic target of rapamycin complex 1 (mTORC1), the main nutrient‐sensitive kinase. Metformin, through inhibition of mTORC1 may improve acne. A 12‐week, randomized, open‐labeled study evaluated the efficacy and safety of metformin as an adjunct for moderate to severe facial acne. In total, 84 patients received either oral tetracycline 250 mg bd and topical benzoyl peroxide 2.5% with or without metformin 850 mg daily. Evaluations constituted lesion counts, the Cardiff Acne Disability Index (CADI), metabolic parameters and treatment success rate (Investigators Global Assessment score of 0 or 1 or improvement of two grades). Treatment success rates were higher in the metformin group (66.7% vs. 43.2%; p = .04). The mean percentage reduction from baseline in total lesion counts at Week 12 was greater in the metformin group (71.4% vs. 65.3%; p = .278). The CADI scores showed a greater mean reduction in the metformin group (4.82 vs. 4.22; p = .451). Metformin was equally efficacious in improving acne in lean and overweight subjects. Gastrointestinal symptoms were noted in 31.7% of subjects on metformin. This study presents favorable data for metformin as an adjunct for acne treatment. Further randomized placebo‐controlled studies are required.     

Experimental testing of skin reactions to insulin detemir in diabetes patients naïve to insulin detemir

Background/aims: Sporadic reports on immediate and delayed cutaneous reactions to insulin detemir, a modern insulin analogue, have raised unsupported claims of allergy of type I, III and IV. The purpose of this experimental study using a provocative design was to elucidate the potential mechanisms behind such skin reactions. Material and methods: A total of 40 patients with type 1 diabetes or insulin‐requiring type 2 diabetes, all naïve to insulin detemir, were injected on the thigh with 0.l mL of insulin detemir (Levemir^®) administered with an 8 mm needle at three different depths, i.e. intradermal, subdermal and subcutaneously. Saline was injected as control. Any cutaneous reactions were assessed after 10 and 30 min, after 24 and 48 h and after 7 days. Histopathology of positive reactions on day 7 was obtained. The study was randomized, controlled, double‐blinded, and conducted in accordance with ICH‐GCP guidelines. Blood flow was recorded with the Periflux PF5010, and skin colour (a^*) with the DSMII colorimeter. Results: Clinical reading, flowmetry and colorimetry consistently showed delayed reactions after intradermal insulin injection (35 of 40 patients reacted with mainly weak reactions, P<0.05), peaking after 48 h, contrasting no special reaction immediately after injection, except for reactions attributed to needle trauma. A total of 22 patients reacted on subdermal injection and 21 on subcutaneous injection. Histopathology on day 7 from 22 reactions in 15 patients showed a consistent pattern of inflammation with eosinophilia as typically observed in adverse skin reactions to a variety of medicines. Reactions were interpreted as non‐specific biologic responses to the insulin different from direct toxic actions and classical allergic reaction patterns. Only one person registered itch/discomfort. A prick test vs. histamine reference excluded insulin detemir to be a pharmacological histamine releaser. Thus, provocative testing with insulin detemir produced delayed skin reaction but no immediate reaction. Measurement of circulating insulin detemir‐specific antibodies by RIA before and after 3 months showed no increase. Conclusion: Non‐allergic delayed skin reactions from intradermal and, to a minor degree, subdermal and subcutaneous injections of insulin detemir were frequent in this experimental study and showed a consistent histology pattern of inflammation with eosinophilia. Immediate reactions were not produced. The reactions are unlikely to be specific for insulin detemir, and other insulins should be studied in a similar provocative design.     

Effective continuous systemic therapy of severe plaque‐type psoriasis is accompanied by amelioration of biomarkers of cardiovascular risk: results of a prospective longitudinal observational study

Background Severe psoriasis is associated with significant cardiovascular mortality. Objectives We investigated the effects of continuous systemic therapy on the cardiovascular risk of patients with severe plaque‐type psoriasis. Methods A total of 42 consecutive patients receiving systemic treatment for their severe plaque‐type psoriasis were included. The clinical course was monitored over 24 weeks. Initially as well as after 12 and 24 weeks, oral glucose tolerance tests were performed along with comprehensive laboratory monitoring. Results Responding patients, defined as a Psoriasis Area and Severity Index (PASI)‐50 response, showed correlations between the PASI and high‐sensitive C‐reactive protein (r = 0.45, P = 0.03) as well as with vascular endothelial growth factor (r = 0.76, P = 0.007). The adipokine resistin was positively and the potentially cardio‐protective adiponectin was negatively correlated with the PASI (r = 0.50, P = 0.02 and r = ?0.56, P = 0.007, respectively). Oral glucose tolerance tests yielded a correlation between the PASI and plasma levels for C‐peptide (r = 0.73, P = 0.02) at t = 120 min in patients with a pathological Homeostasis Model Assessment (>2.5), indicating that the state of peripheral insulin resistance is driven at least in part by the severity of the psoriatic inflammation. Correlations between the change of adipokine levels and change in PASI were more pronounced among patients with better clinical improvement (PASI‐75 vs. PASI‐50). Conclusions We document an amelioration of biomarkers of cardiovascular risk in patients with severe plaque‐type psoriasis responding to continuous systemic therapy. The impact on the patients’metabolic state was found to be better if the psoriatic inflammation was controlled for longer. Future studies need to compare the cardioprotective effects of different treatment modalities, based on hard clinical endpoints.     

Acne‐associated syndromes: models for better understanding of acne pathogenesis

Acne, one of the most common skin disorders, is also a cardinal component of many systemic diseases or syndromes. Their association illustrates the nature of these diseases and is indicative of the pathogenesis of acne. Congenital adrenal hyperplasia (CAH) and seborrhoea‐acne‐hirsutism‐androgenetic alopecia (SAHA) syndrome highlight the role of androgen steroids, while polycystic ovary (PCO) and hyperandrogenism‐insulin resistance‐acanthosis nigricans (HAIR‐AN) syndromes indicate insulin resistance in acne. Apert syndrome with increased fibroblast growth factor receptor 2 (FGFR2) signalling results in follicular hyperkeratinization and sebaceous gland hypertrophy in acne. Synovitis‐acne‐pustulosis‐hyperostosis‐osteitis (SAPHO) and pyogenic arthritis‐pyoderma gangrenosum‐acne (PAPA) syndromes highlight the attributes of inflammation to acne formation. Advances in the understanding of the manifestation and molecular mechanisms of these syndromes will help to clarify acne pathogenesis and develop novel therapeutic modalities.     

The relationship between oxidative stress,smoking and the clinical severity of psoriasis

Background Recent studies suggested that increased oxidant products and decreased antioxidant system functions may be involved in the pathogenesis of psoriasis. In this study, we investigated total oxidative status, Paraoxonase (PON)1/arylesterase enzyme activities and severity of the disease in smoker and non‐smoker psoriatic patients. Methods Fifty‐four patients with plaque type psoriasis (28 smokers and 26 non‐smokers) and 62 healthy volunteers (16 smokers and 46 non‐smokers) were enrolled in the study. Serum total oxidant status (TOS), total antioxidant capacity (TAC) and arylesterase levels were measured, and oxidative stress index (OSI) was calculated in all participants. Results Psoriasis Area and Severity Index scores were significantly higher in smoker patients than in non‐smoker patients (P = 0.014). Both smoker and non‐smoker patients had significantly increased TOS levels and OSI values and decreased TAC levels than healthy subjects (all P values = 0.000). The TAC and TOS levels, OSI values and arylesterase activities were similar between smoker and non‐smoker patients. The levels of triglyceride (TG), total cholesterol (TC), low‐density lipoprotein (LDL) and high‐density lipoprotein (HDL) were not significantly different between smoker and non‐smoker psoriasis patients. When compared with non‐smoking controls, only smoking psoriasis patients had significantly higher TG (P = 0.005), lower HDL (P = 0.022) and lower arylesterase levels (P = 0.015). There were no significant correlations with Psoriasis Area and Severity Index (PASI) scores and TAC, TOS, OSI, TG, TC, HDL and LDL levels in all psoriasis patients. Conclusions Oxidative stress is increased in psoriasis patients regardless of their smoking status. The decreased arylesterase activity in smoker psoriasis patients suggested that smoking may be a considerable risk factor that increases the severity of psoriasis by increasing oxidative stress in these patients.     

Changes in inflammatory markers correlated with increased testosterone after laparoscopic sleeve gastrectomy in obese Chinese men with acanthosis nigricans

Bariatric surgery is an effective method for severe obesity and its related comorbidities. This study was performed to explore the alterations of sex hormones and inflammatory markers following laparoscopic sleeve gastrectomy (LSG) among obese Chinese men with acanthosis nigricans (AN). Sixty‐five obese men who underwent LSG were enrolled, comprising simple obesity without AN (OB group, n = 20) and obesity with AN (AN group, n = 45). There were 31 healthy male controls with normal body mass index (BMI) included. Anthropometry data, inflammatory markers, sex hormones and metabolic parameters were compared preoperatively and 12 months post‐operatively. At baseline, patients in the AN group were associated with more severe metabolic abnormalities than the OB and control groups. Twelve months after surgery, AN patients obtained significant improvement in skin condition and reduction in AN score. BMI, fasting insulin (FINS), and Homeostatic Model Assessment of Insulin Resistance (HOMA‐IR), tumor necrosis factor‐α (TNF‐α) and total testosterone (TT) were significantly changed in both groups, while interleukin (IL)‐6, IL‐8 and C‐reactive protein were changed significantly only in the AN group. Moreover, FINS, HOMA‐IR, TT and IL‐6 levels were changed more in the AN group than those in the OB group. Multivariate regression analysis revealed that TT increase correlated significantly with reduction in FINS and HOMA‐IR in both groups, but correlated with changes in IL‐6 only in the AN group. In conclusion, LSG is effective in improving the skin condition of obese men with AN. The increased TT in AN patients correlated with amelioration of inflammatory state in addition to insulin resistance after LSG.     

Light‐emitting diode 415 nm in the treatment of inflammatory acne: An open‐label,multicentric, pilot investigation

Background. The management of acne remains a challenge, with current therapies linked to significant side effects and patient non‐compliance. Phototherapy using blue light has been proven in the treatment of acne vulgaris and offers the clinician an effective alternative.

Objective. To determine the effect of narrowband light‐emitting diode (LED) blue light in the reduction of inflammatory and non‐inflammatory lesions in patients with mild to moderate acne and to evaluate patient tolerance of the therapy.

Methods. Forty‐five patients were treated with high‐intensity pure blue light, 415?nm and 48?J/cm², receiving two treatments of 20?minutes per week for a period of 4–8 weeks. Clinical assessment was performed at baseline, and 2, 4 and 8 weeks after treatment. A patient's therapeutic response was measured using a global improvement scoring system.

Results. The mean improvement score was 3.14 at 4 weeks and 2.90 at 8 weeks. Nine patients experienced complete clearing at 8 weeks. The treatment was well tolerated, with 50% of patients highly satisfied with the treatment.

Conclusion. This open‐label study suggests the therapeutic efficacy of high‐intensity LED pure blue light in the treatment of acne vulgaris with no reported side effects.     

Enhancing effect of pretreatment with topical niacin in the treatment of rosacea‐associated erythema by 585‐nm pulsed dye laser in Koreans: a randomized,prospective, split‐face trial

Background Rosacea is a chronic dermatosis that is usually confined to the face. A pulsed dye laser (PDL) system has been proven to be effective in treating rosacea‐associated erythema and telangiectasias. Niacin is a cutaneous vasodilator that can increase the chromophore through increased blood flow. Objectives We hypothesized that increased blood flow by pretreatment with topical niacin could enhance the effect of PDL in the treatment of rosacea. Methods Eighteen Korean patients with rosacea were recruited. Three sessions of 585‐nm PDL using a subpurpuragenic dose with and without pretreatment with niacin cream were performed on randomly assigned half‐faces at 3‐week intervals. Erythema was assessed objectively by a polarization colour imaging system, and evaluations were also made by three blinded dermatologists. Patient satisfaction was evaluated using a 10‐point visual analogue scale. Results Fifteen patients completed this study. All patients showed an improvement in erythema after three sessions of PDL treatment both with and without niacin pretreatment (P = 0·023 and P = 0·009, respectively). There was no significant difference in the improvement of objective erythema between the two sides. However, based on physician assessment the overall clinical improvement on the niacin side was significantly higher (P = 0·005), and patient satisfaction was also higher on the niacin‐pretreated side (P = 0·007). There were no remarkable side‐effects, with the exception of transient erythema and oedema. Conclusions Pretreatment with topical niacin safely enhanced the effect of 585‐nm PDL treatment of rosacea‐associated erythema in Koreans. Application of niacin can be helpful in overcoming the relatively lower effect of subpurpuragenic PDL in dark‐skinned Asians.     

Serum zinc-alpha-2 glycoprotein and insulin levels and their correlation with metabolic syndrome in patients with rosacea

Background

Metabolic syndrome and insulin resistance may accompany rosacea. Zinc-alpha-2 glycoprotein (ZAG) is an adipokine involved in lipid, glucose, and insulin metabolism and might be associated with metabolic syndrome and insulin resistance.

Aims

To investigate the serum ZAG levels, presence of metabolic syndrome, insulin resistance, and the correlation between ZAG levels, rosacea severity, and metabolic syndrome in patients with rosacea.

Patients/Methods

Seventy-nine patients with rosacea and 80 healthy volunteers were included. Anthropometric and demographic features, personal and family histories, clinical data, the subtype, severity, and duration of rosacea were recorded. Metabolic syndrome, insulin resistance, and dyslipidemia were evaluated in both groups. Fasting blood sugar, lipid panel, C-reactive protein, sedimentation rate, insulin, and serum ZAG levels were investigated.

Results

Frequency of metabolic syndrome, systolic and diastolic blood pressures, and C-reactive protein levels were significantly higher in the rosacea group (p < 0.001 and p = 0.001, respectively). Frequency of dyslipidemia and insulin resistance did not significantly differ between the groups (p = 0.175 and 0.694, respectively). The mean serum ZAG levels were lower in the rosacea group, but no significant difference was evident. In rosacea patients with metabolic syndrome, serum ZAG levels were significantly lower (p = 0.043); however, serum ZAG levels, insulin, and the homeostasis model assessment-estimated insulin resistance values were significantly higher (p = 0.168, 0.013 and 0.001, respectively).

Conclusion

Metabolic syndrome, high blood pressure, and high C-reactive protein levels were associated with rosacea indicating chronic systemic inflammation. ZAG levels were associated with metabolic syndrome in patients with rosacea but not associated with rosacea subtype and disease severity.     

Dermatoses in overweight and obese children and their relationship with insulin and skin color

Background/Aim

The aim of the present study was to investigate the prevalence of obesity-related dermatoses in obese children, and the association between these dermatoses and insulin resistance as well as skin color.

Methods

Obese, overweight, and normal weight children according to body mass index who were followed up and treated in the outpatient clinics were included in the study. Dermatological examinations of the participants were performed, and fasting insulin and glucose levels were checked.

Results

The obese and overweight children were evaluated as the patient group (70 girls, 41 boys, mean age: 12.37 ± 3.14 years). One hundred one healthy children with normal weight were determined as the control group (59 girls, 42 boys, mean age: 12.15 ± 2.43). The first five common dermatoses in the patient group when compared with the control group were keratosis pilaris (KP), striae distensae, hyperhidrosis, acanthosis nigricans (AN), and plantar hyperkeratosis. The first five dermatoses which were positively correlated with formation and insulin resistance were KP, striae distensae, AN, hyperhidrosis, and plantar hyperkeratosis. According to the Fitzpatrick skin scale, we found that the darker the skin color, the higher the probability of AN and KP (OR, 0.298; 95% CI, 0.106–0.834, p = 0.021; OR, 0.306; 95% CI, 0.117–0.796, p = 0.015, respectively).

Conclusion

Some dermatoses associated with obesity and insulin resistance were not found in obese children, or there was no significant association. These results indicate that many skin morbidities may be prevented by preventing and treating obesity and insulin resistance in the early period.     

Associations of acanthosis nigricans with metabolic abnormalities in polycystic ovary syndrome women with normal body mass index

Acanthosis nigricans (AN) usually correlates to insulin resistance (IR) or obesity in obese populations, but adequate studies on the significance of AN in people with normal body mass index (BMI) have not been performed and discussed. Three hundred and thirty‐nine polycystic ovary syndrome (PCOS) patients with normal BMI (<23 kg/m²) were recruited. The anthropometric and biochemical parameters of these patients were measured. In these patients with normal BMI, 33 (9.7%) women had AN, and six (1.77%) women were diagnosed with metabolic syndrome. Most of the anthropometric and biochemical variables associated with metabolic status were more unfavorable in the AN‐positive group compared with the AN‐negative groups. The prevalence of central obesity, IR and reduced high‐density lipoprotein cholesterol (HDL‐C) level were also significantly higher in the AN‐positive group (P < 0.05). In multiple regression analysis, presence of AN was still significantly associated with IR (odds ratio [OR] = 2.952, 95% confidence intervals [CI] = 1.367–6.376] and reduced HDL‐C level (OR = 2.668, 95% CI = 1.160–6.135) after adjustments for age and BMI. Sensitivity, specificity, and positive and negative predictive values for AN to detect IR were 18.6%, 92.6%, 39.4% and 81.4%, respectively. In conclusion, presence of AN correlated with IR and reduced HDL‐C level in PCOS women with normal BMI. AN status had high specificity to detect IR, but lack of sensitivity.     

Evaluation of subclinical atherosclerosis in Turkish patients with acne vulgaris receiving systemic isotretinoin

Studies conducted on isotretinoin have shown that it may indirectly lead to atherosclerosis. The objective of this study was to determine the effect of systemic isotretinoin on subclinical atherosclerosis. The present study included 63 patients with acne vulgaris who had used isotretinoin for 6 months. Glucose, insulin, and homeostatic model assessment of insulin resistance levels; body mass index; waist circumference; blood pressure; lipid profile; and lectin‐like oxidized low‐density lipoprotein receptor‐1 (LOX‐1), high‐sensitivity C‐reactive protein, and oxidized low‐density lipoprotein (Ox‐LDL) levels were compared in the patients at the initiation and discontinuation of the treatment. At the discontinuation of the treatment, LOX‐1 and Ox‐LDL levels showed a significant increase (P < .001 and P = .040, respectively). Differences in waist circumference were positively correlated with an increase in LOX‐1 levels (r = .274; P = .030). Isotretinoin causes an increase in the levels of subclinical atherosclerosis markers. Although the present study sample size was small, we believe that caution should be exercised considering the risk of atherosclerosis during isotretinoin use in men with high waist circumference and cardiovascular risk factors; further studies are warranted in this regard.     

Stressful life events, anxiety, depression and coping mechanisms in patients with Behçet''s disease

Background Behçet's disease is a systemic immunoinflammatory disease of young adults characterized by systemic vasculitis of arteries and veins. Although many studies have been published since its discovery in 1937, the etiopathogenesis of this unique disorder is still unclear. Objective To assess the relationship between stress factors, psychological and somatic symptoms, and coping mechanisms in patients with Behçet's disease. Method Thirty‐four patients with Behçet's disease and 43 control subjects were compared by using sociodemographic data collection forms, a psychosocial and environmental problems list, the Beck Anxiety Inventory (BAI), Hamilton Depression Rating Scale (HAM‐D) and Toronto Alexithymia Scale (TAS). Results Twenty‐four patients (70.6%) defined stress factors in the first stage of the disease. Twenty‐seven (79.4%) out of 34 patients stated that the recurrence period of the disease was related to the stress factors. Fear was expressed by 10 (29.4%) patients, sadness by 11 (32.3%), and fear plus sadness by 13 (38.2%) when they first learnt the diagnosis. While coping with these emotions 14 (41.2%) revealed active‐reliance strategy. A statistically significant difference was present between the Behçet's patients and control subjects regarding TAS (P < 0.05), HAM‐D (P < 0.001) and BAI (P < 0.001) scores. Conclusion It seems that stressful life events have important implications in both relapsing and remission periods of Behçet's disease via secondary problems.     

Adiponectin levels,insulin resistance and their relationship with serum levels of inflammatory cytokines in patients with Behçet’s disease

Aim Increased frequency of cardiovascular disease and its possible relations with insulin resistance have been reported in patients with inflammatory diseases. The aim of our study was to investigate insulin resistance and serum adiponectin levels as cardiovascular risk markers in patients with Behçet’s disease. Method Study population consisted of 40 patients with Behçet’s disease (BD) and a control group composed of age, gender, body mass index‐matched 46 healthy individuals. All patients were examined for signs of Behçet’s disease. Body mass index, waist and hip circumference were measured. Insulin resistance was evaluated using the homeostasis model assessment‐insulin resistance method. Erythrocyte sedimentation rate (ESR), lipid profile, high sensitive CRP (hsCRP), adiponectin, TNF‐α, IL‐6 and IL‐8 levels were measured. Results Erythrocyte sedimentation rate, serum hsCRP and IL‐6 levels were significantly higher in patients with BD than those in the controls (P = 0.001, P = 0.001, P = 0.001, respectively). Fasting plasma glucose, insulin levels and lipid profile were not different between the two groups. Insulin resistance and decreased levels of the serum adiponectin were not detected in the patients. There was no relationship between insulin resistance, adiponectin levels and inflammatory markers. Active and inactive patients did not differ in respect of any parameters. Conclusion Being a systemic vasculitis, BD may cause cardiovascular involvement. In this study, dyslipidemia, insulin resistance and low adiponectin levels were not detected among our patients with Behçet’s disease. Our results suggest that there exists no increased risk for atherosclerotic cardiovascular disease associated with adiponectin levels and insulin resistance in patients with Behçet’s disease.     

Immunological effects of stress in psoriasis

Background Psychological stress causes phenotypic changes in circulating lymphocytes and is regarded as an important trigger of the Th1‐polarized inflammatory skin disease psoriasis. Objective To study the effects of psychological stress on immunological parameters, i.e. membrane molecules relevant to the pathophysiology of psoriasis, especially cutaneous lymphocyte‐associated antigens (CLA) involved in T and natural killer (NK) cells homing in on the skin. Methods The severity of psoriasis was assessed in patients using the Psoriasis Area and Severity Index. Patients with psoriasis (n = 15) and healthy volunteers (n = 15) were exposed to brief psychological stress in the laboratory. In vitro analyses were conducted 1 h before, immediately following and 1 h after stress exposure. Peripheral T‐ and NK‐cell subsets including CD8+ T lymphocytes, CLA+ lymphocytes and lymphocyte function‐associated antigen type 1 (LFA‐1)+ lymphocytes were analysed by flow cytometry. Results We found a significant stress‐induced increase of CD3+ T lymphocytes in patients with psoriasis only. Analyses of T‐cell subsets revealed that this increase was observable for cytotoxic CD8+ T lymphocytes and CLA+ CD3+ lymphocytes. The total number of circulating NK cells (CD16+, CD56+) increased immediately after stress in both groups whereas only patients with psoriasis showed a significant increase in CLA+ NK cells. Conclusions A higher stress‐induced increase of CLA+ T and CLA+ NK cells in the circulation of patients with psoriasis might point to an increased ability of T and NK cells in the presence of psoriasis to home in on the skin during mental stress. Further studies are needed to verify these relationships in more detail and to investigate the time point at which these cells accumulate within lesional skin, and whether or not psychotherapy improves the quality of life of patients with psoriasis and influences stress‐dependent parameters.