Medicine by Alexandros G. Sfakianakis: 10/03/17

Τρίτη 3 Οκτωβρίου 2017

Issue Information

IL-36 in hidradenitis suppurativa: Evidence for a distinctive pro-inflammatory role and a key factor in the development of an inflammatory loop

Abstract

Background

A possible regulatory involvement of the interleukin (IL)-36 family in inflammatory diseases has been suggested.

Objectives

To analyze the expression of IL-36α, β, γ, and the antagonistic cytokines IL-36Ra, IL-37, and IL38 in the skin of hidradenitis suppurativa (HS) patients.

Methods

Skin samples from lesional and corresponding perilesional HS skin, and from healthy controls were included in this study and analyzed by quantitative real-time RT-PCR. To evaluate the PCR results of IL-36α, β, and γ, a subset of skin samples was studied by immunohistochemistry.

Results

Expression levels of IL-36α, β, γ, and IL-36Ra were all significantly higher in lesional HS skin compared to healthy controls. IL-37 and IL-38 were significantly higher in perilesional HS skin compared to healthy controls and decreased in lesional HS skin.

Limitations

Descriptive study and small sample size.

Conclusions

Our results showed a possible involvement of IL-36 cytokines in the inflammatory network of HS and a dysbalance between the agonistic and antagonistic cytokines in HS skin.

Systemic retinoids and psychiatric disorders in patients with skin diseases: a multifactorial relationship

Abstract

Le Moigne and colleagues reviewed case reports to examine a possible causal linkage between systemic retinoids and psychiatric disorders.¹ The authors conclude that systemic retinoids should be prescribed with vigilance for patients with psychiatric disorders. While we agree with a need for vigilance, we caution against prematurely concluding that there is a causal association.

Calcipotriene/betamethasone dipropionate for the treatment of psoriasis vulgaris: an evidence-based review

Genital Diseases in the Mature Woman

Publication date: Available online 3 October 2017
Source:Clinics in Dermatology
Author(s): Natalie Matthews, Vivian Wong, Joe Brooks, George Kroumpouzos
Vulvovaginal conditions are common in mature women. This reflects age-related changes in immunity and skin barrier function of vulvovaginal tissues. Vaginal atrophy is commonly complicated by dryness and inflammation which makes postmenopausal atrophic vaginitis a virtually ubiquitous condition. The differential of vaginitis includes inflammatory, infectious, and malignant diseases, plus drug hypersensitivity. Atrophic vaginitis is treated with estrogen replacement therapy. Vulvovaginal malignant melanoma occurs predominantly in postmenopausal women and carries a poor prognosis. Similarly, the incidence of vulvovaginal malignancies, such as squamous cell carcinoma and extramammary Paget disease, rises exponentially after 65years of age. Early diagnosis of these malignancies is of utmost importance. Lichen sclerosus et atrophicus and vulvovaginal candidosis are among the most common postmenopausal vulvovaginal conditions. Lichen sclerosus et atrophicus is associated with significant morbidity, and its management can be challenging. The incidence of vulvovaginal candidosis increases in patients on estrogen replacement therapy.

Drug eruptions in the mature patient

Publication date: Available online 3 October 2017
Source:Clinics in Dermatology
Author(s): Ronni Wolf, Branka Marinović
The world's population is now ageing at an unprecedented rate. Declining fertility and improved health and longevity have generated rising numbers and proportions of the older population in most parts of the world. With advancing age, however, comes an increasing incidence of disease, comorbidity or multi-morbidity, an increasing use of medications, polypharmacy, and consequently an increase in adverse drug reactions (ADR). Age-related changes in pharmacodynamics and pharmacokinetics (e.g., volumes of drug distribution, metabolism and clearance, altered drug responsiveness and toxicity, etc.), and greater vulnerability to ADRs are other reasons for the higher incidence of ADR in the elderly compared to young adults. Because the clinical pattern of adverse drug reactions are very similar for all age groups including the elderly, the present review will deal mainly with statistics and numbers, rather than the clinical and/or disease patterns.

COMMENTARY-The Mature Patient: geriatric dermatology

Publication date: Available online 3 October 2017
Source:Clinics in Dermatology
Author(s): Branka Marinović

Therapeutic challenges in the mature patient

Publication date: Available online 3 October 2017
Source:Clinics in Dermatology
Author(s): Zrinka Bukvić Mokos, Anamaria Jović, Romana Čeović, Krešimir Kostović, Ivica Mokos, Branka Marinović
With the tremendous increase in the proportion of seniors in the global population, geriatric health care has become of greater interest and concern. Increased emphasis on geriatric medicine along with the growth in the development of age-related skin disorders has led to particular attention for geriatric dermatology and dermato-pharmacology. An aging population has brought many therapeutic challenges that we need to recognize and overcome by applying geropharmacologic principles. The purpose of this paper is to inform dermatologists of the age-related changes in the pharmacokinetics of common dermatologic drugs, their various interactions potentially occurring in the elderly, and the principles and evidence-based strategies for detection, management, and prevention to improve medication adherence. By implementing these principles and strategies, we can ensure the best and the safest treatment to promote the desired therapeutic outcome and improved quality of life for this fragile subpopulation.

Blistering Diseases in the Mature Patient

Publication date: Available online 3 October 2017
Source:Clinics in Dermatology
Author(s): Ines Lakoš Jukić, Sandra Jerković Gulin, Branka Marinović
Autoimmune blistering diseases (AIBD) are a group of chronic diseases affecting the skin and mucous membranes, with different presentation, clinical course, histologic and immunopathologic findings and different therapeutic approach. Blisters develop as a result of autoantibodies directed against distinct adhesion structures within desmosomes or within basement membrane zone, Most common autoimmune blistering disease that develop in elderly is bullous pemphigoid (previously also named pemphigoid senilis), but mature patients can also present with other AIBDs as mucous membrane pemphigoid, epidermolysis bullosa aquisita, paraneoplastic pemphigus, pemphigus vulgaris, pemphigus foliaceus, linear IgA dermatosis, and dermatitis herpetiformis. There are no differences in treatment approach to mature patients with AIBD, but due to more common comorbidities systemic therapy should be given with more caution and control and due to distorted skin integrity in the aged skin, the safety concerns are increased with the long-term use of any topical medication.

Psoriasis in the mature patient - therapeutic approach in the era of biologics

Publication date: Available online 3 October 2017
Source:Clinics in Dermatology
Author(s): Kresimir Kostovic, Kristina Zuzul, Romana Ceovic, Zrinka Bukvic Mokos
Management of psoriasis in elderly patients may be challenging due to a small number of studies investigating this specific population. When treating a mature patient, special consideration should be given to multiple comorbidities, progressive functional impairment of several organs, immunosenescence, possible adverse effects, and polypharmacy. Due to the chronic nature of the disease and continuing rise in life expectancy, the prevalence of psoriasis among elderly is also expected to rise. Because many different therapies are available for treatment of psoriasis, we have reviewed those that have been investigated in the aging population. Although the biologics have revolutionized the therapy of psoriasis due to targeted mechanism of action, high efficacy and low rate of adverse events, studies on the elderly population with psoriasis are scarce. Further clinical research and development of specific treatment guidelines in geriatric population are needed in order to optimize the therapeutic approach in this population.

Hair and Nail Diseases in the Mature Patient

Publication date: Available online 3 October 2017
Source:Clinics in Dermatology
Author(s): Austin John Maddy, Antonella Tosti
The elderly population is growing, lifespans are increasing, and a greater emphasis on geriatric care is being implemented in hospital systems. With a higher percentage of the population living longer, hair and nail diseases associated with the advanced stages of life are becoming more prevalent. Common hair diseases in the elderly include androgenetic alopecia, senile alopecia, frontal fibrosing alopecia, and erosive pustular dermatosis of the scalp. Nail diseases associated with advanced age include onychomycosis, brittle nails, onychocryptosis, onychoclavus, onychogryphosis, subungual hematomas, subungual exostosis, myxoid cysts, and malignancies. These diseases can have a serious impact on a patient's quality of life. In an effort to familiarize the reader with these common changes and abnormalities, we discuss hair and nail diseases in the mature patient.

Cutaneous infections in the mature patient

Publication date: Available online 3 October 2017
Source:Clinics in Dermatology
Author(s): Maria Cristina Ribeiro de Castro, Marcia Ramos-e-Silva
The dermatologist must be familiar with the peculiarities of the micro-organism that may afflict the elderly, in order to optimize the diagnosis and treatment of infections, which may affect their skin, especially because the world population is rapidly aging and, in 2050, there will be 434 million individuals over 80years of age.

Skin Barrier and Dry Skin in the Mature Patient

Publication date: Available online 3 October 2017
Source:Clinics in Dermatology
Author(s): Ružica Jurakić Tončić, Sanja Kezić, Suzana Ljubojević Hadžavdić, Branka Marinović
Dry skin is the most common symptom of dermatologic diseases, and it presents with itching, redness, and desquamation, signs and symptoms that are not only physically uncomfortable but also affect patients psychologically. The water content in the stratum corneum (SC) is largely dependent on the composition and amount of the intercellular lipids which regulate the loss of water from the skin and on the levels of hygroscopic substances of the natural moisturizing factors (NMF), which are responsible for the retention of water in the SC. The prevention of water loss and penetration of potentially toxic substances and microorganisms into the body are the most important functions of the skin which acts as a natural frontier between the inner organism and the environment. Skin barrier defects occur in several skin diseases, but the influence of ageing on skin barrier function is largely unknown and conflicting results have been reported. In this review, the structure and the function of the barrier in relation to the aging process are discussed.

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Τρίτη 3 Οκτωβρίου 2017

Abstract

Background

Objectives

Methods

Results

Limitations

Conclusions

Abstract