Ana Ravić-Nikolić

Systemic photochemotherapy decreases the expression of IFN-γ, IL-12p40 and IL-23p19 in psoriatic plaques

Psoriasis vulgaris (PV) is a chronic skin disease with unclear pathogenesis. In the present study we investigated the effect of systemic photochemotherapy (PUVA therapy- psoralen and UVA therapy) on the expression of IFN-γ, IL-12p40 and IL-23p19 in lesional psoriatic skin. Fifteen patients with chronic plaque type psoriasis selected to be treated with PUVA therapy were recruited for this study. Expression of IFN-γ, IL-12p40 and IL-23p19 in psoriatic lesions before and after twenty PUVA treatments was established by using immunohistochemistry (IHC). A significant decrease in expression (p < 0.05) of IFN-γ, IL-12p40 and IL-23p19 in epidermis and dermis of psoriatic lesions was observed. The immunosuppressive effect of PUVA therapy presented with decreased expression of biologically active IL-23 (IL-12/IL-23p40 + IL-23p19) as a part of the Th17 pathway, and IFN-γ (Th1 pathway) led, in our patients, to a marked clinical improvement as shown by PASI (before therapy 20.55 and after therapy 3.33).

Actinic reticuloid presented as facies leonine

Kyriakos P. Kyriakis, MD, MPH Koumanoudi str 52 Athens 11474 Greece E-mail: fountou@otenet.gr References 1 Yeatman JM, Kilkenny M, Marks R. The prevalence of seborrhoeic keratoses in an Australian population: does exposure ton sunlight play a part in their frequency? Br J Dermatol 1997; 137: 411–414. 2 Rothman KJ. Stratified analysis. In: Modern Epidemiology. Boston, MA: Little Brown, 1986: 177–239. 3 Memon AA, Bothwell J, Tomenson J, Friedman PS. Prevalence of solar damage, keratosis and skin cancer in an English population. Br J Dermatol 1995; 132: 646.

Self-inflicted ulcerations.

Dear Editors, Self-inflicted ulceration, as part of dermatitis artefacta, is a rare condition often diagnosed by exclusion as clinical, histological and laboratory findings do not comply with any known disease (1). Patients with such skin lesions also suffer from psychiatric diseases such as schizophrenia, dementia, personality disorders and so on (1). As far as treatment is concerned, best results are achieved with regular follow up care and administration of occlusive wound dressings (1). We present the case of a 60-year-old woman, diagnosed and treated for depression and dementia, with three deep ulcerations, bordered by erythematous halo and covered with thick yellow-black necrotic crusts, localized only on the front side of the lower extremities (Figure 1). The patient denied injury of any kind, but her family members stated that she was often seen scratching her skin with subsequent forming of the ulcers. She had also tried to clean one ulcer with bleach while she was cleaning the bathroom. As a result, a net of coagulated blood vessels was visible on the largest ulcer (Figure 2). Results of routine laboratory tests (sedimentation rate, complete blood count, biochemical and urine analysis) were within normal limits; immunological studies [anti-nuclear antibody (ANA), anti-neutrophil cytoplasmic antibody (ANCA), antiRoSS-A, anti-LaSS-B, immunocomplexes, immunoglobulins, rheumatological factor and lupus anticoagulant test], virological examination [human immunodeficiency virus (HIV), hepatitis B and C viruses] and pathergy test were also negative.

Generalized Pustular Psoriasis in Association with Squamous Cell Carcinoma of the Hypopharynx

Abstract Pustular psoriasis is an uncommon form of psoriasis consisting of widespread pustules on an erythematous background. Very rarely pustular psoriasis represent a paraneoplastic dermatosis. In this report we describe a case of generalized pustular psoriasis (GPP) associated with advanced, inoperable, metastatic squamous cell carcinoma of the hypopharynx. We suggest that physicians should be alert for the worsening of existing psoriasis or formation of novel psoriasiform eruptions and should undertake clinical evaluation of possible neoplastic disease.

Electrical burns: Letter to the Editor

Dear Editors, Electrical injuries are not so common in clinical practice. Among other sources, they can occur because of direct contact with high-tension electric current (1). The impact of electric current can have severe consequences that lead to invalidity and death. There are varieties of electrical injuries based on the clinical appearance, and the final outcome depends on the voltage of the source, resistance of the victim, type of the electric source, the pathway it follows through the body and duration of contact (1).

Atrophoderma of Pasini and Pierini associated with extramedullary plasmacytoma.

A 34-year-old man presented with a 3-month history of well-defined, symmetrical lesions localized in his axillae and on both sides of the trunk. His medical and family history was unremarkable. He had initially been treated by his general practitioner with 40 mg/day of prednisolone for 7 days, with tapering of the dose during the following 2 weeks. As there was no improvement, the patient was referred to us for further examination and treatment. On physical examination, asymptomatic, hyperpigmented, nonindurated, slightly depressed plaques with distinct, abrupt margins were seen on the patient’s skin (Fig. 1a,b). Histopathological examination showed a normal epidermis, a mild mononuclear perivascular infiltrate and homogenization of collagen fibres with unaffected adnexal structures in the dermis (Fig. 2a). The collagen fibres stained blue with Masson trichrome staining (Fig. 2b). Laboratory investigations showed that erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were elevated. Complete blood count, biochemical analysis and urine analysis were within the normal range. Serological examination for Borrelia burgdorferi and virological analyses (hepatitis C and B virus, human immunodeficiency virus) were negative. Chest radiography and abdominal ultrasonography did not reveal any abnormalities. A diagnosis of atrophoderma of Pasini and Pierini (APP) was made, and the patient was treated with oral doxycycline 200 mg/day for 14 days and local potent corticosteroid ointment, but there was no clinical improvement. Three months later, the patient developed dyspepsia. Gastroduodenoscopy did not show any abnormalities, but suspected retroperitoneal lymphadenopathy was observed with abdominal ultrasonography and confirmed with computed tomography scanning. Enlarged lymphatic nodes (diameter 57 mm) were present in the retroperitoneum (Fig. 2c). A laparotomy of the retroperitoneal lymph nodes and affected part of colon was performed. A diagnosis of extramedullary plasmacytoma (EMP) was postulated based on the clinical (painless, firm and solitary tumour formation, 100 mm in diameter in epigastrium), histopathological (tissue biopsy showed presence of plasma cells) and immunohistochemical

Generalized eruptive xanthomas associated with diabetic dyslipidemia

A 39-year-old, obese male, (body mass index 41.3 kg/m2) presented to the Department of Dermatology with generalized, diffuse, pruritic skin lesions. According to the patient, the first skin lesions had begun to appear a few years before, on the extensor side of the elbows and shoulders. Two months before dermatological examination, new skin lesions appeared in crops on the trunk and extremities, with a tendency to generalization. Physical examination showed small, generalized, pruritic, yellowish [...]