In vivo assessment of iron and ascorbic acid in psoriatic dermis

Reactive oxygen species play an important role in inflammatory skin diseases such as psoriasis. Reactive oxygen species synthesis is catalysed by iron and some species are scavenged by ascorbic acid. The aim of this work was to assess iron and ascorbic acid in uninvolved and involved psoriatic dermis and to compare the corresponding concentrations in the dermis of healthy subjects. Microdialysis associated with atomic absorption spectrometry and gas chromatography-mass spectrometry was used to assess iron and ascorbic acid, respectively. Seven psoriatic patients and five healthy volunteers were studied. Iron concentrations in the involved (57.1 +/- 19.3 microg/l) and uninvolved (49.7 +/- 27.1 microgl/l) psoriatic dermis were higher than the corresponding value determined in the dermis of healthy subjects (21.8 +/- 2.4 microg/l) (p<0.05). Ascorbic acid in involved (47.3 +/- 8.2 microg/ml) and uninvolved (42.0 +/- 14.0 microg/ml) psoriatic dermis was statistically lower than that found in healthy dermis (176.8 +/- 29.0 microg/ml) (p<0.05). These results demonstrate that psoriatic patients exhibit high iron and low ascorbic acid concentrations in the dermis, but there were no significant differences between involved and uninvolved skin.     

Antioxidant enzymes and lipid peroxidation in the scalp of patients with alopecia areata

Alopecia areata (AA) is an autoimmune inflammatory disease. However, little is known about the alterations in lipid peroxidation and antioxidant enzymes in the scalp of patients with AA. Therefore, the aim of this study was to investigate the status of oxidative stress in the scalp of patients with AA. We measured the levels of thiobarbituric acid reactive substances (TBARS) as lipid peroxidation status, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) as antioxidant enzymes in the scalp of ten patients with AA and ten control subjects. The levels of TBARS in scalp of patients with AA (3654.1+/-621.2 nmol/g tissue) were significantly higher than those of controls (1210.2+/-188.8 nmol/g tissue) (P=0.002). The levels of SOD (134.8+/-23.8 U/g tissue) and GSH-Px (332.7+/-66.2 U/g tissue) in scalp of patients with AA were also significantly higher than those of controls (63.2+/-8.8 U/g tissue, 112.0+/-18.4 U/g tissue, respectively) (P=0.019, P=0.002, respectively). The mean levels of TBARS, SOD and GSH-Px in early phase of disease were increased 2-fold as compared with late phase of the disease. These results indicate that oxidative status is affected in AA. Lipid peroxidation and antioxidant enzymes may be involved in the pathogenesis of AA. Furthermore, we found high SOD and GSH-Px activities in the scalp of patient with AA. These high levels could not protect the patients against the reactive oxygen species, because lipid peroxidation could not be lowered in AA patients.     

Serum levels of vasoactive intestinal peptide are elevated in patients with atopic dermatitis

Vasoactive intestinal peptide (VIP) has been suggested to play some roles in atopic dermatitis. Tissue of VIP levels has been reported to increase in chronic lichenified lesions of atopic dermatitis (AD). To analyze whether serum levels of VIP in AD patients are elevated compared with normal controls and correlated with the disease severity, we measured serum levels of VIP using enzyme-linked immunosorbent assay in 53 patients with AD and 21 healthy individuals. The results showed that serum levels of VIP in AD patients (345.8+/-71.5 microg/ml) were significantly higher than those in healthy individuals (307.1+/-42.6 microg/ml). However, a correlation was not found between serum VIP levels and disease severity, other markers including serum LDH levels, total serum IgE levels, and peripheral blood eosinophil counts in patients with AD. This indicates that VIP levels in AD patients were elevated not only in the skin but also in the serum, suggesting that increased serum VIP levels in the patients with AD might be involved in its pathogenesis.     

Increased urinary leukotriene E4 excretion in patients with atopic dermatitis

BACKGROUND: Synthesis of cysteinyl leukotrienes (LTs) is known to play a part in the pathogenesis of inflammatory diseases. OBJECTIVES: To define the involvement of cysteinyl LTs in atopic dermatitis (AD). METHODS: Synthesis of cysteinyl LTs was assessed in patients with AD and healthy volunteers by measuring urinary LTE4, a useful index of systemic cysteinyl LT synthesis, using liquid chromatography/tandem mass spectrometry. RESULTS: Mean +/- SD urinary LTE4 levels in patients with AD (125 +/- 69 pg mg(-1) creatinine, n = 20) were significantly higher (P < 0.01) than in healthy volunteers (60 +/- 19 pg mg(-1) creatinine, n = 17). A significant correlation between urinary LTE4 and total serum IgE levels in patients with AD was observed (r = 0.643, P < 0.05). CONCLUSIONS: Our findings demonstrate an enhanced synthesis of cysteinyl LTs in patients with AD and suggest that cysteinyl LTs are involved in the pathophysiology of AD.     

The effect of azithromycin on reactive oxygen species in rosacea

BACKGROUND: Recent evidence suggests that inflammation in rosacea is associated with generation of reactive oxygen species (ROS) that are released by inflammatory cells. The efficacy of current therapeutic agents for rosacea such as tetracyclines and metronidazole has also been attributed to their antioxidant properties. Recently, a macrolide antibiotic, azithromycin, has been found to be an effective alternative in the treatment of rosacea. AIM: We planned a study to evaluate the antioxidant effects of azithromycin on ROS in rosacea. We compared basal ROS concentrations measured in the facial skin of patients with rosacea with the post-treatment levels and with those of healthy controls. METHODS: Facial skin biopsies of 17 papulopustular patients with rosacea and 25 healthy controls were taken. Rosacea patients were assigned to receive oral azithromycin 500 mg on three consecutive days each week for 4 weeks. The total number of inflammatory lesions (the sum of papules and pustules) on the face of each patient with rosacea was counted at each visit. The luminol- and lucigenin-enhanced chemiluminescence (CL) levels of patients with rosacea were measured before and after 4 weeks of treatment and compared with those of healthy controls. RESULTS: Rosacea patients had higher ROS levels than healthy controls (P < 0.001). A statistically significant decrease of both luminol- and lucigenin-enhanced CL levels were observed in patients with rosacea after treatment with azithromycin (t = 4.602, P < 0.001; vs. t = 4.634, P < 0.001, respectively). CONCLUSION: Rosacea patients have higher ROS levels than healthy controls. The results of our study support the antioxidant properties of azithromycin in rosacea.     

Homocysteine: An activity marker in Behçet's disease?

BACKGROUND: Beh?et's disease (BD) is a chronic multisystem inflammatory disorder commonly complicated by vascular thrombosis. OBJECTIVE: In this study, we investigated whether hyperhomocysteinaemia, being a well known risk factor for atherothrombogenesis, is also a contributive risk factor for the pathogenesis and the activation of Beh?et's disease. METHODS: Sixty-four patients fulfilling the criteria of the International Study Group for Beh?et's disease (48 males, 16 females, 33+/-8 years) were enrolled. They were separated into two groups with respect to activation features of Beh?et's disease. Additionally, we collected the blood samples from 13 patients with BD in both active stage and in inactive stage. Twenty-six healthy individuals were included as a negative control group. Serum total homocysteine (Hcy) levels were determined by chemiluminescence immunoassay. RESULTS: Mean serum homocysteine concentrations in total BD patients were significantly higher than in the healthy controls (11.7+/-4.6 versus 8.7+/-2.8micromol/L, p<0.01). Mean serum homocysteine concentrations in the active patients were significantly higher than in the inactive patients and the healthy controls (13.3+/-3.6; 10.8+/-5.0; 8.7+/-2.8micromol/L, respectively) (p<0.05 and p<0.001, respectively). There was no significant difference between the patients with inactive disease and the healthy controls. When the active and the inactive stage of 13 patients with BD were compared, we found that mean serum total homocysteine levels were higher in the active stage than in the inactive stage (p<0.05). CONCLUSION: Hyperhomocysteinaemia may be responsible for the endothelial damage in BD and assumed to be a risk factor and a marker for activation of BD.     

Interferon-gamma in alopecia areata

Alopecia areata is a common type of hair loss. In clinical practice most patients will present with reversible patchy hair loss whereas others may develop complete baldness. Although the etiopathogenesis of alopecia areata is poorly understood, evidence is accumulating that it can be regarded as a T-cell mediated tissue-restricted autoimmune disease of the hair follicle, especially expressing the T-helper-type 1 cytokines interleukin-1beta, interleukin-2, and interferon-gamma. The aim of the study was to compare the serum levels of interferon-gamma in patients with alopecia areata and the control group and also to investigate the difference between the localized form of the disease with the extensive forms like alopecia totalis (AT) and alopecia universalis (AU). Forty patients with alopecia areata and 20 healthy controls were enrolled in the study. Nineteen patients had localized AA (LAA) and twenty-one patients had AT, AU or AT/AU. The serum levels of interferon-y were measured using enzyme immunoassay techniques. The mean serum IFN-gamma level in AA patients (n = 40) was 14.25 +/- 8.76 pg/mL (mean +/- SD), whereas that of LAA (n = 19) or extensive (AT, AU or AT/AU) (n = 21) was 13.45 +/- 6.75 pg/mL or 14.98 +/- 10.37 pg/mL, respectively. The mean serum IFN-gamma level in controls was 9.95 +/- 2.6 pg/mL. Serum levels of IFN-gamma in patients with AA were significantly higher than those in controls (p < 0.05). Significant difference was observed in serum levels of IFN-y between patients with LAA and control group (p < 0.05). Serum levels of IFN-gamma in patients with AT, AU or AT/AU were significantly higher than those in controls (p < 0.05). There was no significant difference in levels of IFN-gamma between patients with LAA and extensive group (p > 0. 05). We conclude that the elevated serum levels of IFN-gamma may reflect the inflammatory symptoms in AA, especially in the extensive form and that control of IFN-gamma production may be important to management of this disease. And also the measurement of serum IFN-gamma in patients with AA may be useful in discriminating those likely to progress to AU from the remaining LAA, or as a prognostic indicator.     

Increased plasma adrenomedullin levels in patients with Behçet's disease

BACKGROUND: Beh?et's disease (BD) is a chronic systemic inflammatory disorder affecting multiple organs with a generalized vasculitis of arteries and veins. Endothelial dysfunction is one of the prominent features of BD. Adrenomedullin (AM) is a peptide produced not only in normal adrenal medulla but also in the vascular smooth muscle cells and endothelial cells, and its role in the course of BD has not been previously described. OBJECTIVE: To detect changes of plasma AM concentrations in patients with BD compared with age- and sex-matched healthy subjects by using high-performance liquid chromatography (HPCL). We also investigated if disease activity or the duration of BD correlates with AM levels. METHODS: Forty-two consecutive patients with BD (38.5 +/- 11.1 years, 19 male and 23 female) and 20 healthy age- and sex-matched control subjects (39.5 +/- 10.9 years, 8 male and 12 female) were included in this study. We measured plasma AM levels by HPCL, and acute-phase reactants including alpha(1)-antitrypsin and alpha(2)-macroglobulin, neutrophil count and the erythrocyte sedimentation rate. RESULTS: Mean +/- SD plasma AM levels in patients with BD (73.22 +/- 25.55 pmol/l) were significantly higher (p < 0.001) than in healthy control volunteers (21.35 +/- 12.37 pmol/l). Patients with active BD had similar plasma AM concentrations (79.32 +/- 21.89 pmol/l) with patients with inactive disease (67.44 +/- 29.92 pmol/l). On the other hand, patients with longer duration of the disease (mean duration, 13.9 +/- 3.8 years) had significantly higher plasma AM levels (83.99 +/- 19.71 pmol/l; p = 0.005) than patients (62.45 +/- 26.57 pmol/l) with shorter duration of the disease (mean duration, 5. 5 +/- 2.3 years). All acute-phase reaction parameters were found to be significantly increased in the active disease. CONCLUSION: Considering its endothelial cell implications, AM may be involved in reparatory vessel endothelium mechanisms, especially in the chronic disease.     

Iron, Copper, and Zinc Concentrations in Normal Skin and in Various Nonmalignant and Malignant Lesions

The concentrations of zinc (Zn), copper (Cu), and iron (Fe) in the skin have been noninvasively determined in vivo by diagnostic x-ray spectrometry. The skin of healthy controls was divided into two major groups based upon the distribution of the concentrations of these elements. In the face and upper neck, the following wet weight concentrations were recorded: Fe, 14.2 +/- 3.3 ppm; Cu, 1.3 +/- 0.3 ppm; and Zn, 6.7 +/- 1.1 ppm. In the chest, abdomen, arm, axilla, and lower neck, the concentrations of these elements were as follows: Fe, 10.2 +/- 2.5 ppm; Cu, 0.8 +/- 0.3 ppm; and Zn, 4.5 +/- 1.7 ppm. In most lesions of solar dermatitis, solar keratosis, basal and squamous cell carcinomas, variable elevations of Zn and Fe (up to significant levels) were recorded in most of the contralateral, apparently uninvolved skin. In the majority of pigmented nevi and malignant melanomas, the levels of Fe and Zn were elevated. In some of these, the Cu concentration also was increased.     

Leu7 (HNK-1)-positive cells in peripheral blood and natural killer cell activity in patients with atopic dermatitis]

To clarify the immunologic abnormalities in patients with atopic dermatitis (AD), the percentages of Leu7 (HNK-1)-positive cells and natural killer (NK) cell activity were measured in peripheral blood lymphocytes isolated from 25 AD patients (8 males and 17 females, mean age of 20.8 years old) and 69 healthy non-atopic persons (46 males and 23 females, mean age of 27.4 years old). The percentage of Leu7-positive cells was significantly reduced in AD patients compared with that in controls (AD patients: 11.6 +/- 7.0%, controls: 19.5 +/- 8.3%, p less than 0.01). Although the difference was not statistically significant, reduction of the percentage was slighter in patients with mild AD than in moderate and severe AD patients (mild AD: 14.3 +/- 6.6%, moderate AD: 10.1 +/- 4.4%, severe AD: 10.5 +/- 8.3%). There was also a significant inverse correlation between the percentage of Leu7-positive cells and log IgE levels in patients with AD (r = -0.537, p less than 0.01). No differences in NK cells activity or NK cell activities augmented by interferon-beta and interleukin-2 were observed between in AD patients and in controls. These results suggest that the Leu7-positive cells in AD patients may be closely associated with the regulation of serum IgE production.     

Determination of iron status in women attending genitourinary clinics with pruritus vulvae

OBJECTIVE: To compare iron status in women with pruritus vulvae and in asymptomatic controls. METHODS: 42 women with pruritus vulvae and 42 asymptomatic broadly age-matched controls were enrolled in this prospective study. The outcome measures assessed were serum iron, serum ferritin, total iron-binding capacity, haemoglobin and transferrin saturation. RESULTS: 12 (29%) participants and 10 (24%) controls were iron deficient; 1 (2%) participant and 1 (2%) control had laboratory-defined iron deficiency anaemia. Participants generally had lower levels of iron markers than controls, with differences (95% confidence interval (CI)) of -3.5 microg/l (-9.89 to 6.99) for serum ferritin (p = 0.73), -4.9 mmol/l (-8.12 to 0.12) for serum iron (p = 0.06) and -5.5 mmol/l (-5.75 to 1.46) for total iron-binding capacity (p = 0.24). No significant difference in haemoglobin or mean cell volume was shown between the two groups (haemoglobin: p = 0.17, 95% CI -0.83 to 0.15; mean cell volume: p = 0.15, 95% CI -4.59 to 0.73). CONCLUSION: This study does not provide evidence to support the routine determination of iron status in patients presenting to genitourinary medicine clinics with pruritus vulvae from all causes.     

Atopic dermatitis: immunophenotyping of inflammatory cells in skin lesions

BACKGROUND: The ever increasing incidence of atopic dermatitis (AD) has stimulated many researchers to use various diagnostic procedures to obtain new data to help elucidate the pathogenesis of the disease. AIMS: To perform cell immunophenotyping and to analyze the presence of inflammatory cell-surface markers in the biopsies of skin lesions from 15 AD patients and five healthy subjects. METHODS: Immunohistochemical analysis was performed in a group of AD patients and compared with that in a control group of healthy subjects. Avidin-biotin immunoperoxidase staining of paraffin-embedded, 4 microm skin sections, with semiquantitative counting of cells labeled with anti-CD3, anti-CD8, anti-CD20, anti-HLA-DR (HLA, human leukocyte antigen), and anti-immunoglobulin E (anti-IgE) primary antibodies, was used. RESULTS: The results of AD skin analysis showed a greater infiltration of CD3+ lymphocytes, especially of CD4+ subtype, compared with CD8+ lymphocytes. AD skin biopsy specimens also showed a higher intraepidermal HLA-DR+ Langerhans' cell count, the presence of HLA-DR on lymphocytes in the dermis, and higher intraepidermal expression of IgE+ cells compared with healthy controls. CONCLUSIONS: A statistically significant difference (P < 0.05) was found between the two groups for intradermal and intraepidermal CD3, CD4, and HLA-DR, intradermal CD8, and intraepidermal IgE+ cells. Immunophenotyping was found to be a useful diagnostic method in AD patients.     

Substance P levels are decreased in lesional skin of atopic dermatitis

There is increasing evidence that neuropeptides (NP) such as substance P (SP) and vasoactive intestinal polypeptide (VIP) are involved in the pathogenesis of atopic dermatitis (AD). Vasoactive intestinal polypeptide levels were found to be significantly elevated in lesional skin of AD as compared to controls. We evaluated by radioimmunoassay the SP content in whole skin homogenates from chronic lichenified lesions of patients with AD. The levels of SP were significantly decreased in lesional skin from AD patients as compared to control skin (0.25 +/- 0.03 vs. 0.97 +/- 0.24 pmol/g tissue, p < 0.01). The diminished SP levels as opposed to increased VIP concentrations could be consistent with different roles of these NP as modulatory agents in the mechanisms associated with AD.     

Levels of fusidic acid in skin blister fluid and serum after repeated administration of two dosages (250 and 500 mg)

The fusidic acid steady-state concentrations in serum (S) and skin suction blister fluid (SBF) after oral doses of 250 and 500 mg administered twice daily for 6 days, as film-coated tablets of sodium fusidate, were studied in eight healthy subjects. The mean peak serum concentrations after the 250- and 500- mg regimens were 39 +/- 5 and 102 +/- 11 mg/l, respectively, obtained between 2 and 3 h after drug intake. The corresponding values for SBF, obtained later, between 2 and 12 h after drug intake, were 21 +/- 5 and 79 +/- 11 mg/l. As measured by the ratio of area under the concentration vs. time curve (SBF/S), fusidic acid penetration is 69-75%, whatever the dose. With either regime, the fusidic acid SBF and serum levels exceed the minimal inhibitory concentration of bacteria usually found in skin infections, especially Staphylococcus species. A dose of 250 mg twice a day appears sufficient to treat these infections and could be tested in clinical studies.     

Quantitative analysis of tryptase- and chymase-containing mast cells in atopic dermatitis and nummular eczema

The distribution of mast cells (MCs) containing tryptase (T) and chymase (C) was studied in the non-lesional and lesional skin of 26 patients with atopic dertnatitis (AD) and 23 patients with non-atopic nummular eczema (NE). and in the skin of eight healthy controls. T and C activities were demonstrated enzymehistochemically using 2-Gly-Pro-Arg-MNA and Suc-Val-Pro-Phe-MNA as substrates, respectively. The T- and C-containing MCs were counted separately in the epidermis, in contact with the basement membrane. In the papillary dermis and in different dermal levels (0·2 mm each). Also, the C protein was determined immunohistochemically. T-positive MCs were similarly distributed in non-lesional and lesional skin of both AD and NE. The MC number was relatively high in the upper dermis (papillary dermis and levels I and I!) of non-lesional and lesional skin of AD. In the upper dermis of non-lesional AD and NE skin and in normal skin, about 50% of T-positive MCs displayed C activity, whereas the percentage in lesional AD and NE skin was only about 30%. hi this respect, the non-lesional and lesional samples differed significantly froLu each other in both dennatoses (in AD p = 0%005, in NEP = 0·002. Students' t-test). In all samples the MC number decreased in the deeper dermal levels, although numerous T-containing MCs were still counted in the deeper dermis (dermal levels IV-VII) of lesional AD and NE skiti. differing significantly from the MC number in normal skin (In ADp = 0·005. in NE p=0·041). In the deeper dermis. the percentage of MCs containing active C was about 70% in non-lesional and lesional AD and NE. and about 90% in normal healthy skin. However, in the upper dermis of non-lesional and lesional skin of both AD and NE. about H()% of all MCs contained the C protein, which differed significantly from the value of 100% in normal skin (p<0·5). In conclusion, the increased number of T-positive MCs in the upper dermis of non-lesional and lesional AD contributes to promoting inflammation. C apparently loses its activity in the upper dermis of lesional AD and especially in NE. Thus. Ihe enzyme partially lacks its capability to suppress inflammation, such as degradation of neuropeptides and proteins. The dysregulation of these proteinases exists already in non-lesional skin of AD and NE.     

PIXE analysis in different stages of psoriatic skin

Elemental distribution in psoriatic skin varies with the functional state of the keratinocytes, e.g., electrolytes influence cell metabolism and cell proliferation, and trace elements play a crucial role in a great number of enzymes. Elemental distribution in pinpoint lesions, old plaques, and uninvolved skin of 5 psoriatic patients and 4 healthy controls was studied by means of PIXE (proton-induced x-ray emission) analysis. This technique allows the simultaneous detection of elements with an atomic number greater than or equal to 14 along the epidermis and dermis in freeze-dried skin biopsies. Trace elements such as Fe, Cu, and Zn were determined down to a level of 1 ppm. In comparison with uninvolved skin, concentrations of P and K were elevated in psoriatic epidermis. In addition, increased levels of K were correlated with the stage of the psoriatic lesion. Zinc concentrations were significantly elevated in pinpoint lesions. The Zn concentration profiles within the epidermis and upper dermis showed high correlation to the P concentration profiles. Iron levels were decreased in old psoriatic plaques, whereas Cu concentrations varied considerably. In comparison to the controls, Cl concentrations were markedly decreased in the dermis of involved and uninvolved psoriatic skin, whereas epidermal Cl levels were unaffected. As high K levels prevent the Ca-induced differentiation of keratinocytes, high K levels may be the cause of the high cell differentiation in psoriatic skin. Elevated DNA- and RNA-polymerases might be the cause of elevated Zn levels in pinpoint lesions.     

Immunomodulating cytokines in atopic dermatitis and psoriasis: production of tumour necrosis factor and lymphotoxin by mononuclear cells in vitro

The immunomodulating cytokines, tumour necrosis factor/cachectin (TNF) and lymphotoxin (LT) are thought to play an essential role as mediators of inflammatory reactions. To evaluate the role of TNF and LT in atopic dermatitis (AD) and psoriasis, we investigated their production by mononuclear cells (MNC) in vitro. The 24-h supernatants of lipopolysaccharide (LPS)- and phytohaemagglutinin (PHA)-stimulated and unstimulated MNC from 26 patients with AD and 20 with psoriasis and from 17 non-atopic healthy controls were tested for the concentrations of TNF and LT using an ELISA technique. In patients with AD, TNF levels were significantly decreased in the supernatant of PHA-stimulated (P less than or equal to 0.005) and LPS-stimulated (P less than or equal to 0.02) MNC in comparison to controls. There was no significant difference in TNF production between psoriatic patients and the control group. Release of LT in the supernatant of PHA-stimulated MNC by patients and controls did not differ significantly. There was no significant spontaneous production of TNF and LT by MNC of patients and controls. These studies indicate that different immunomodulating mechanisms are responsible for triggering the inflammatory response in AD and psoriasis.     

Microdialysis of histamine in the skin of patients with mastocytosis

Mastocytosis represents a group of disorders characterized by the proliferation and accumulation of mast cells in tissue. The aim of the present study was to examine whether the interstitial histamine concentration in the skin is increased in mastocytosis patients and whether it correlates with the number of mast cells, the amount of metabolite N-methyl-imidazole acetic acid in the urine and the tryptase in serum. In 7 mastocytosis patients on a standardized diet, the analysis of histamine was performed on microdialysates obtained from catheters positioned intracutaneously in involved and uninvolved skin. N-methyl-imidazole acetic acid in the urine was collected for 24 h. Biopsies for analyses of mast cells were taken from skin adjacent to the microdialysis catheters. The histamine concentrations were 42+/-14, 12+/-3 (P<0.05) and 8+/-2 nmol/l (mean+/-SEM, n=7) in skin eruptions, non-lesional skin and plasma respectively. Mean N-methyl-imidazole acetic acid in the urine (9.7+/-3.5 mmol/mol creatinine) and mean tryptase (124+/-54 microg/l) had increased in all patients. In the present study, no linear correlation was found between these parameters and interstitial histamine in lesional skin. This finding corresponds to the fact that the concentration of histamine metabolites and tryptase derives from the entire mast-cell population, while interstitial histamine in the dermis represents the local tissue concentration before metabolic transformation. The microdialysis of histamine in the skin of mastocytosis patients could be used as a tool to investigate the effects of dermal mast-cell histamine release in different kinds of treatment regimen.     

Increased serum levels of tumor necrosis factor alpha in lichen planus

BACKGROUND: Lichen planus (LP) is a common, pruritic, inflammatory mucocutaneous disease. There are several opinions and approaches to the etiopathogenesis of LP. Immunologic mechanisms almost certainly mediate its development. T-cell-mediated immunity plays the major role in triggering the clinical expression of the disease. The cytokines that are produced by lymphocytes also play an important role in the development of LP. OBJECTIVE: The goal of our study was to investigate the possible role of tumor necrosis factor alpha (TNF-alpha) in the pathogenesis of LP. METHODS: Serum TNF-alpha levels were determined with the enzyme-linked immunosorbent sandwich assay method in the sera of 40 patients suffering from LP and in those of 40 healthy controls. RESULTS: The serum levels of TNF-alpha were found to be significantly higher in the patient group compared to the healthy controls (patients: 35.64 +/- 9.59 pg/ml, controls: 15.6 +/- 3.97 pg/ml, p < 0.001). CONCLUSION: Our results revealed that TNF-alpha might play a major role in the pathogenesis of LP.     

Atopische Dermatitis und psychischer Stress

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease. Its main features are eczematous skin lesions with a typical distribution and severe pruritus. Allergens, skin irritants, systemic or local infections, environmental pollutants and hormonal changes have a role in the pathophysiology of AD. A further important trigger factor for both intrinsic and extrinsic AD is emotional stress. Recently published observations point to direct psychoneuroimmunological and -endocrinological mechanisms: Psychological stress causes a transient increase of peripheral blood eosinophil count and an increase in both CD8+/CD11b+ and CLA+ T-cells. In addition, stress changes the cytokine and the hormone profile with increased levels of IFN-gamma and IL-5, and decreased levels of cortisol in AD patients in contrast to healthy controls. These findings underline the role of immunological changes and a possible suppressed hypothalamic-pituitary-adrenal (HPA) axis closing the loop for the final aggravation of AD.