Skin disorders in chronic psychiatric illness

Background Chronic psychiatric patients are prone to develop skin diseases. However, epidemiological data are scarce. Objective To describe the prevalence of skin complaints and dermatological disorders in residential psychiatric patients. Methods Ninety‐one randomly chosen patients of the residential wards of a general psychiatric hospital completed a short, structured interview concerning skin disease and underwent a physical examination of the skin. Results Of the examined patients, 69% reported symptoms of skin disease in the month prior to the interview and 77% had skin disorders at physical examination. In 34 (37%) patients, skin disorders were diagnosed, which were not mentioned in the interview. Patients with diabetes had infectious skin disease more often than their fellow patients [odds ratio (OR) 10.9; 95% confidence interval (CI): 2.40–49.75]. Moreover, overweight patients had infectious skin disease more often (OR 7.4; 95% CI: 1.38–39.3). Women reported more skin complaints (OR 6.4: 95% CI: 1.67–24.2), and also had skin problems other than infection, tumours or dermatitis more frequently (OR 3.7; 95% CI: 1.34–10.14). Clozapine use was associated with benign neoplasms of the skin. The nature of this association remains unclear and merits further investigation. Conclusions Many chronic psychiatric patients have skin problems. Clinical examination of the skin is important to discover these problems. Patients with diabetes mellitus are particularly at risk for skin infections. Because of their relationship with overweight and diabetes mellitus, atypical antipsychotics may be partly responsible for these serious complications. Only a few other relationships between psychiatric medication and specific skin problems were found.     

糖尿病相关皮肤病易感基因的研究进展

皮肤病变是糖尿病常见的并发症,其病因机制尚不清楚,近期研究发现部分与糖尿病相关的皮肤病变（如：银屑病、白癜风、黑棘皮病等）与糖尿病具有相同的易感基因,本文总结了最近5年此类皮肤病与糖尿病相关易感基因的研究进展。     

Prisoners and skin diseases in Toulouse, France: epidemiological analysis and evaluation of life impact

Background   Dermatology in a penitentiary environment is an under-researched field.
Objectives   To study the prison population seeking medical advice for skin diseases and to assess among detainees the life impact of these diseases, an approach that to the best of our knowledge has not previously been reported.
Methods   This prospective study was carried out in the male population of two penal institutions in the region of Toulouse, south-western France.
Results   One hundred seventy-eight men were seen, for a total of 234 diagnoses and 281 consultations. The five most frequent diagnoses, in order of decreasing frequency, were disorders of the pilosebaceous follicle, fungal diseases, benign skin tumours, warts and eczemas, which are common skin diseases. However, 72% of inmates believed their skin disease was directly related to detention. This belief was related to the conditions of life in prison (seclusion and its effects) and to frequent psychological problems.
Conclusions   The disorders observed were generally benign skin conditions that could be expected in a population of young men living in a closed community. They led to a high demand for care and treatment: skin diseases represented the largest specialist consultation in our institutions. Skin problems can easily be managed in an outpatient unit, which confirms the usefulness of a dedicated dermatology clinic within the outpatient consultation units of penal institutions in order to provide care of equivalent quality to that available in a free environment. The dermatologist can have an important role in the medical management and the health education of prisoners.     

Treatment outcome and incidence of psychiatric disorders in dermatological out-patients

OBJECTIVE: Epidemiological studies have shown that the prevalence of psychiatric disorders among dermatological patients is high. We aimed at estimating the short-term incidence of psychiatric disorders among patients with skin disease. METHODS: The 12-item General Health Questionnaire (GHQ-12) was used to identify subjects free from psychiatric morbidity at their first dermatological visit. The GHQ-12 was administered again after 1 month during a computer-assisted telephone interview. RESULTS: A total of 277 subjects was included in the study. At the follow-up interview, 21 (7.6%) were found to have significant psychiatric morbidity. Only lack of improvement was associated with increased incidence of psychiatric morbidity (13.6%), with an odds ratio of 3.1 (95% confidence interval 1.2-7.8), after adjustment for gender, age, educational level and clinical severity. CONCLUSIONS: Physicians should devote special attention to the risk of psychiatric complications in patients who have not improved with treatment.     

Trends of skin diseases in organ‐transplant recipients transplanted between 1966 and 2006: a cohort study with follow‐up between 1994 and 2006

Background Skin diseases are frequently observed in organ‐transplant recipients (OTRs). Objectives To count the registered skin diseases in all 2136 OTRs who had been transplanted in a single centre between 1966 and 2006 and to calculate their relative contribution in relation to the number of years after transplantation. Methods All registered skin diseases which were entered into a computerized system between 1994 and 2006 at the Leiden University Medical Centre were counted and their relative contributions were calculated. Results Between 1994 and 2006, 2408 skin diseases were registered in 801 of 1768 OTRs who were at risk during this specific time period. The most commonly recorded diagnoses were skin infections (24·0%) followed by benign skin tumours (23·3%) and malignant skin lesions (18·2%). The relative contributions of infectious and inflammatory disorders decreased with time after transplantation, whereas the contribution of squamous cell carcinomas strongly increased with time. Conclusions This study gives a systematic overview of the high burden of skin diseases in OTRs. The relative distributions of skin diseases importantly changed with time after transplantation, with squamous cell carcinoma contributing most to the increasing burden of skin diseases with increasing time after transplantation.     

High frequency,diversity and severity of skin diseases in a paediatric emergency department

Background Skin disorders are a major concern in the Paediatric Emergency Department (PED). We provide an accurate evaluation of the incidence, characteristics and severity of skin disorders seen in our PED over a 1‐year period. Methods A total of 20 652 children’s medical notes were reviewed in a single centre, retrospective study in the PED of a University Hospital over a 1‐year period. The dermatological disorders were analysed on the basis of different criteria including their incidence, patient age, sex ratio, diagnosis, seasonal variations and hospitalization rates. Results A total of 1897 (9.2%, F/M: 1.2; mean age: 4.1 ± 3.6 years) children presented with 1999 skin diseases and 69 different diagnoses. This frequency increased in the summer months (more than 14% of all patients). A total of 46.5% of diseases were infectious in nature (27.6% viral and 14.4% bacterial), inflammatory diseases accounted for 26.2% (urticaria and angio‐oedema 15.9%, atopic dermatitis 3.5%, Henoch‐Schönlein purpura: 2.1%), non‐specific focal disease (balanitis, vulvitis, etc.) and insect bites, burns, transient diseases of the newborn and drug reactions for 9.2%, 7.8%, 6.4%, 3.7% and 1.2% respectively. More than 90% of children presented at the hospital for an acute condition and 155 (8.2% of children with skin disorders; F/M: 0.9; age: 4.0 ± 4.0 years) were hospitalized. More than 90% of hospitalizations were for infectious and inflammatory diseases. Conclusion Our data reveal the extremely high frequency, diversity and potential severity of paediatric emergency skin disorders. Specific educational measures and closer co‐operation between Dermatologists and Paediatricians are essential if the skin care dispensed to children and teenagers is to be improved.     

Scleroderma-like lesions in insulin-dependent diabetes mellitus

We report on two patients (one female 42 years, one male 47 years) suffering from insulin-dependent diabetes mellitus (IDDM) for more than 20 years. Both patients exhibited sclerodactyly and sclerosis of the hands and lower arms as well as swelling and slight contracture of the distal interphalangeal joints. Interestingly, internal organs were not involved and autoantibodies characteristic for scleroderma were missing. Poor utilization and excess of glucose seem to be responsible for the activation of fibroblasts to produce abundant matrix proteins in the skin. Significant therapeutic improvement of the glucose metabolism was able to improve joint contractures or at least to stop the progression of skin changes in our patients. These skin changes should not be misdiagnosed as systemic sclerosis.     

Glycosylated proteins of skin, nail and hair: application as an index for long-term control of diabetes mellitus

The purpose of the present study was to compare the degrees of nonenzymatically glycosylated proteins in the skin (stratum corneum), the nail, the hair, and hemoglobin obtained simultaneously from the same subject and to evaluate the most useful sample for management of diabetic complications. Fifty-one diabetic patients and 20 control patients were examined, utilizing furosine determination. Furosine value of the skin in diabetics was 2.14 +/- 1.70%, whereas that in controls was 1.65 +/- 0.47%. Furosine value of the nail in diabetics was 6.67 +/- 3.30%, whereas that in controls was 4.16 +/- 1.62%. Furosine value of the hair in diabetics was 1.30 +/- 1.11%, whereas that in controls was 1.29 +/- 1.71%. Close correlations were detected between HbA1 (glycosylated hemoglobin) and furosine of the nail (r = 0.58, p less than 0.001), HbA1 and furosine of the skin (r = 0.48, p less than 0.001), and HbA1 and furosine of the hair (r = 0.43, p less than 0.01); however, poor correlations were found between furosine of the hair and the skin (r = 0.35, p less than 0.05) and furosine of the nail and the hair (r = 0.33, p less than 0.05). Furosine of the nail was significantly correlated with the FBS (fasting blood sugar) of the same time, previous 6, and previous 12 months. Furosine value of the nail, we believe, is the most useful indicator for evaluating long term control of diabetics and may provide useful information for management of diabetic complications.     

A long-standing hyperglycaemic condition impairs skin barrier by accelerating skin ageing process

Uncontrolled chronic hyperglycaemia including type 2 diabetes mellitus (DM) induces many skin problems related to chronic impaired skin barrier state. However, little is known about the skin barrier state of chronic hyperglycaemia patients, the dysfunction of which may be a major cause of their skin problems. In this study, we investigated whether a long-standing hyperglycaemic condition including type 2 DM impairs skin barrier homoeostasis in proportion to the duration and its pathomechanism. We utilized the Otsuka Long-Evans Tokushima Fatty (OLETF) rats as an animal model of long-standing hyperglycaemia and Long-Evans Tokushima Otsuka rats as a control strain. We confirmed that a long-standing hyperglycaemia delayed skin barrier homoeostasis, which correlated with haemoglobin A1c levels. OLETF rats as a long-standing hyperglycaemia model exhibited decreased epidermal lipid synthesis and antimicrobial peptide expression with increasing age. Decreased epidermal lipid synthesis accounted for decreased lamellar body production. In addition, OLETF rats had significantly higher serum levels of advanced glycation end products (AGEs) and elevated levels of the receptor for AGE in the epidermis. A long-standing hyperglycaemic condition impairs skin barrier function including permeability and antimicrobial barriers by accelerating skin ageing process in proportion to the duration of hyperglycaemia, which could be a major pathophysiology underlying cutaneous complications of DM.     

Mechanistic study of endogenous skin lesions in diabetic rats

Please cite this paper as: Mechanistic study of endogenous skin lesions in diabetic rats. Experimental Dermatology 2010; 19 : 1088–1095. Abstract: Pathological and physiological changes in dermal tissue in a rat model of diabetes mellitus (DM) were investigated. Sixteen male 8‐week‐old Sprague–Dawley rats were randomized into two groups of eight, the DM group (Group DM) and the normal control group (Group (NC) normal control). Group DM rats were injected with streptozotocin (STZ) intraperitoneally at a dose of 65 mg/kg body weight. Group NC rats were injected with the same volume of citric acid buffer. All rats were sacrificed 12 weeks later. The impact of exposure to (AGE) advanced glycation end products‐modified human serum albumin (AGE‐HSA) on epidermal cells and ECV304 cells was evaluated in cell culture experiments. The diabetic rats exhibited changes in skin tissue, including a decrease in thickness, disappearance of the multilayer epithelium structure, degeneration of collagen fibres and an increase in the infiltration of inflammatory cells, in addition to a significant increase in skin glucose and AGEs. Moreover, diabetic rats had increased plasma glycosylated protein (GSP) and malondialdehyde (MDA) and decreased plasma glutathione (GSH). The percentage of epidermal cells in S phase was similar between the two group rats; however, there was a marked decrease in the G2/M phase in Group DM. Additionally, exposure of ECV304 cells to AGE‐HSA led to a time‐dependent and dose‐dependent increase in apoptosis. Therefore, the high glucose in the skin tissue, coupled with the accumulation of toxic substances such as AGEs, promote the dysfunction of dermal cells and/or the matrix. This may be a significant mechanism of diabetes‐induced early‐stage endogenous skin damage.     

Comparison of cheek and forehead regions by bioengineering methods in women with different self-reported cosmetic skin types

Background/aims: Understanding structural and functional differences between facial areas is necessary for the formulation of cosmetics and dermatological preparations well tailored to the skin's biophysical characteristics. The objective of the present study was to compare biophysical parameters on malar and frontal facial areas of healthy women classified according to self-reported cosmetic skin types.
Methods: The study population comprised 253 women aged from 20 to 50 years who did not display any signs of dermatological disease. Women declared spontaneously their cosmetic skin type. Skin capacitance, sebum casual level, skin temperature, transepidermal water loss (TEWL), skin colour and relief were assessed on cheeks and forehead in a controlled environment.
Results: All biophysical parameters showed statistically significant differences between the two zones. Mean a* chromametric values and TEWL values were significantly higher on cheeks. In contrast, mean b * chromametric values and sebum casual levels showed the highest values on the forehead. Moreover, skin capacitance, temperature, roughness and L .* chromametric value showed minor, while statistically significant, differences between the two zones. With marginal exceptions, the differences between the facial zones for each biophysical parameter remained statistically significant, irrespective of self-reported skin type.
Conclusion: Biophysical parameter mean values differ between frontal and malar zones regardless of self-reported skin type. Except for the elevated sebum casual levels in greasy and combined skin, no single or combined biophysical characteristics could be linked to any of the self-reported skin types. Furthermore our data confirm that in contrast to the common belief that dry skin is associated with reduced sebum production, sebum levels in women declaring to have dry skin and those declaring to have normal skin were not found to be different.     

Plectin and human genetic disorders of the skin and muscle

Abstract Recent progress in understanding the molecular organization of the cutaneous basement membrane zone (BMZ) has revealed an intricate network of structural proteins necessary for stable association of the epidermis to the underlying dermis. Molecular genetics of the cutaneous BMZ has also revealed that defects in as many as nine distinct genes within the dermal-epidermal junction which result in different forms of epidermolysis bullosa (EB). a group of heritable mechano-bullous disorders. We have recently demonstrated that a variant of EB associated with late-onset development of muscular dystrophy (EB-MD. MIM no. 226670) results from mutations in the gene encoding plectin (PLEC1). a cytoskeleton associated attachment protein present in the hemidesmosomal inner plaque and the sarcolemma of the muscle. Consequently, mutations in this multi-functional gene/protein system can result in phenotypic manifestations of EB-MD both in the skin and the muscle. In this overview, we will summarize the domain organization of plectin and the structure of the corresponding gene (PLEC1). as well as the genetic basis of EB-MD in families studied thus far. Elucidation of the molecular basis of this subtype of EB adds to our understanding of the structural and functional complexity of the cutaneous BMZ.     

Quantitative measurement of desquamation and skin elasticity in diabetic patients

Background/aims: Diabetes mellitus is responsible for many cutaneous alterations. Xerosis and sclerotic change of the skin are the most common findings. Recently non- invasive computerized devices have been developed and used for determining the desquamation rate and measuring the mechanical properties of the skin. Using these devices, the necessity to characterize the conditions of the skin in the healthy as well as the diseased state is increasing. The aim of this study was to compare the elasticity and desquamation rate between the diabetic population and the normal population using non-invasive, objective methods.
Methods: Skin sites of 96 diabetics with normal appearance, were measured for skin elasticity and desquamation rate using the Cutometer^® and visual grading and D-Squame^®– image analysis method, respectively. The values of parameters were compared to values of 83 non-diabetics' results.
Results: There was a significant decrease in skin elasticity (expressed by Uv/Ue and Ur/Uf of the face) and in the value of fine flakes in the diabetics. Although insignificant, the SDI (Scale Density Index) calculated from objective automatic measurement was higher in the diabetics than the control group.
Conclusions: The elasticity of facial skin was decreased in patients with diabetes. Decrease of the fine flakes of the diabetes patients reflect that irritation and xerotic changes are aggravated in skins of diabetic patients. The results indicate the presence of skin elasticity alteration and desquamation with diabetes mellitus. Such non-invasive evaluations of the skin may be useful for evaluating changes in the skin that are associated with diabetes mellitus.     

Impaired glyoxalase activity is associated with reduced expression of neurotrophic factors and pro‐inflammatory processes in diabetic skin cells

Patients suffering from type II diabetes develop several skin manifestations including cutaneous infections, diabetic dermopathy, diabetic bullae and acanthosis nigricans. Diabetic micro‐ and macroangiopathy as well as diabetic neuropathy are believed to play a crucial role in the development of diabetic skin disorders. A reduced cutaneous nerve fibre density was reported in diabetic subjects, which subsequently leads to impaired sensory nerve functions. Using an innervated skin model, we investigated the impact of human diabetic dermal fibroblasts and keratinocytes on porcine sensory neurons. Diabetic skin cells showed a reduced capacity to induce neurite outgrowth due to a decreased support with neurotrophic factors, such as NGF. Furthermore, diabetic keratinocytes displayed insulin resistance and increased expression of pro‐inflammatory cytokines demonstrating the persistent effect of diabetes mellitus on human skin cells. Dysregulations were related to a significantly reduced glyoxalase enzyme activity in diabetic keratinocytes as experimentally reduced glyoxalase activity mimicked the increase in pro‐inflammatory cytokine expression and reduction in NGF. Our results demonstrate an impaired crosstalk of diabetic skin cells and sensory neurons favouring hypo‐innervation. We suggest that reduced methylglyoxal detoxification contributes to an impaired neurocutaneous interaction in diabetic skin.     

Decreased incidence of nonmelanoma skin cancer in patients with type 2 diabetes mellitus using insulin: a pilot study

BACKGROUND: In order to prevent the propagation of genetic mutations, human keratinocytes irradiated with ultraviolet (UV) B light in vitro undergo premature stress-induced senescence or apoptosis. This response to UVB irradiation is dependent on the functional activation of the insulin-like growth factor-1 receptor (IGF-1R). Based on this in vitro functional data, we hypothesized that the increased serum levels of insulin in patients with type 2 diabetes may activate the IGF-1R in skin and lead to a decreased frequency of skin cancer in these patients. OBJECTIVES: To determine whether the use of insulin by patients with type 2 diabetes correlated with a change in the incidence in nonmelanoma skin cancer (NMSC). METHODS: A historical cohort study identifying the incidence of NMSC following the use of two different pharmacological therapies. The patient population was restricted to caucasians who were at least 50 years old when they began the indicated pharmacological therapy. The first group consisted of 1440 patients who used insulin therapy to treat type 2 diabetes and the second group comprised 4135 patients who used cimetidine to treat their gastrointestinal ailments. An additional group of 6131 patients with diabetes who used noninsulin antidiabetics was added to examine the effect of noninsulin therapies. All patients had regular follow-up visits at the Regenstrief Clinics during the study period between 1980 and 1999. The Regenstrief Clinics is an outpatient facility which serves the general population in Metro-Indianapolis, Indiana, U.S.A. RESULTS: The incidence of NMSC in patients using insulin was significantly lower than in patients using cimetidine (1.25% vs. 2.35%, P < 0.02). The decrease in NMSC in patients with type 2 diabetes correlated specifically with the use of insulin (NMSC incidence insulin-only patients with diabetes: 1.40% vs. those with diabetes using noninsulin therapies: 2.35%, P = 0.11). CONCLUSIONS: Patients using exogenous insulin had a lower risk of developing NMSC and the protective effect of insulin use becomes more distinct with increasing age.