Ayça Cordan Yazici

The changes in expression of ICAM-3, Ki-67, PCNA, and CD31 in psoriatic lesions before and after methotrexate treatment

Although the effectiveness of methotrexate (MTX) in the treatment of psoriasis is very well established, the mechanism of action is poorly understood. It was suggested that the therapeutic effect of MTX in psoriasis might be mediated by inhibition of adhesion molecule expression. The aim of our study was to investigate the different effects of MTX treatment on cell proliferation, inflammatory infiltrate, adhesion molecules, and angiogenesis in psoriasis, and to clarify the mechanism by which MTX exerts its therapeutic effects. Clinical response, the morpho–phenotypic changes, epidermal thickness, and mitosis count were analyzed and the expression of CD31 and ICAM-3, proliferative markers such as Ki-67, PCNA, were evaluated by immunohistochemical techniques in lesional psoriatic epidermis, before and after the treatment with MTX in ten patients. In posttreatment biopsies a decrease in the degree of epidermal hyperplasia and a significant reduction in the severity of the inflammatory infiltrate (P<0.05) were observed. In addition, CD31 and ICAM-3 expression was significantly decreased on dermal cellular infiltrate, (respectively; P<0.05, P<0.01). Ki67 and PCNA expression were suppressed concurrently in about 90% of cases (P<0.01). We suggest that MTX may have an inhibitory effect on an initial integral component of the pathways that lead to psoriasis. Immunopharmacologic intervention in adhesion event has the potential to improve psoriasis. Inhibition of revascularization may be another mechanism of action of MTX.

Idiopathic guttate hypomelanosis: idiopathic or ultraviolet induced?

Idiopathic guttate hypomelanosis (IGH) is a common but often unrecognized skin disease with obscure etiopathogenesis. As the lesions mostly develop on the exposed parts of the extremities, ultraviolet has been hypothesized to induce these lesions. However, previous statistical studies did not confirm any association between ultraviolet and IGH. We describe a 72‐year‐old woman with mycosis fungoides in whom widespread IGH occurred during narrow band ultraviolet B (UVB) therapy. The lesion development in the trunk following narrow band UVB therapy suggests that these lesions may not be idiopathic and they may be associated with UV exposure although controversy exist in the literature. This case is particular as it reveals strong evidence on this relationship.

Neutrophilic dermatosis of the hands (localized Sweet's syndrome) in association with chronic hepatitis C and sarcoidosis

Summary We report a case of recurrent localized Sweets syndrome (SS) with pulmonary sarcoidosis and hepatitis C virus infection. Hepatitis C may be the triggering factor for both Sweets syndrome and sarcoidosis through stimulation of T helper 1 immune responses involved in the pathogenesis of both diseases.

Celecoxib-induced photoallergic drug eruption.

Photoallergic dermatitis is caused by a photosensitizing substance plus sunlight exposure in a sensitized person. If the photosensitizer is delivered internally, it is called a photoallergic drug reaction. Celecoxib is a new generation non‐steroidal anti‐inflammatory drug and sulfonamide derivative. We report a photoallergic drug eruption associated with the introduction of celecoxib. To our knowledge, this is the first report of photoallergic drug reaction associated with celecoxib.

GSTM1 and GSTT1 null genotypes as possible heritable factors of rosacea

Purpose: Rosacea might be related to an increased activity of reactive oxygen species (ROS) and deficient function of the antioxidant system. Glutathione S‐transferases (GSTs) play a primer role in cellular defense against electrophilic chemical species and radical oxygen species. We hypothesized that increased ROS activity or decreased antioxidant potential, possibly induced by GST gene polymorphism, might have a pathogenic role in rosacea.

The eclipse naevus and cockade naevus: are they two of a kind?

of excessive fat deposits, and weight loss might also be beneficial. While the genes for congenital generalized lipodystrophy and familial partial lipodystrophy have recently been idendified, the pathogenesis of acquired partial lipodystrophy remains unknown. However, it has been associated with autoimmune diseases, in particular renal disease. Up to one-third develop mesangiocapillary (membranoproliferative) glomerulonephritis, typically years after the onset of the lipodystrophy. Complement anomalies have been implicated in its pathogenesis. Patients commonly have low complement C3 levels and circulating C3 nephritic factor, and in vitro studies have shown C3 nephritic factor to cause lysis of adipose tissue. Other reported associations include systemic lupus erythematosus, dermatomyositis, hypothyroidism and pernicious anaemia, coeliac disease and dermatitis herpetiformis, rheumatoid arthritis, temporal arteritis, leucocytoclastic vasculitis, Raynaud’s phenomenon and cutaneous vasculits, and POEMS syndrome. In most cases the partial lipodystrophy preceded the associated disorder by years. C3 nephritic factor was not detected in the majority of these cases, suggesting another factor responsible for the changes seen in patients with partial lipodystrophy.

Isolated lip involvement in psoriasis

A 22-year-old woman presented with a 5-year history of scaling and cracking of the lips. The lesions involved both lips completely, but the surrounding skin remained uninvolved during this period and she had no skin lesions. She complained of a burning sensation on her lips and severe discomfort during eating and speaking. She had been prescribed various medications including emollient creams and topical steroids, with no effective improvement and short remission time. Dermatological examination revealed diffuse mild erythema, adherent silvery scales and fissuring on both upper and lower lips, with minimal extension over the vermilion border (Fig. 1). The remaining oral mucosa and surrounding skin appeared normal. She had no psoriatic or any other skin lesions, and was otherwise in good general health. Routine laboratory examinations were normal. There was no personal or family history of psoriasis or any other dermatological conditions, and no history of smoking. Because of the chronic nature of the lesions and failure of multiple therapies, an incisional biopsy was taken from the lower lip. On histological examination, lamellar hyperkeratosis, parakeratosis and squamous epithelium with psoriasiform hyperplastic rete pattern, and intracorneal pustules consistent with psoriasiform dermatitis were detected. Periodic-acid–Schiff stain for fungal hyphae was negative. Based on these findings and the clinicopathological correlation, a diagnosis of isolated lip psoriasis was made. An emollient cream and a mometasone furoate 0.1% ointment once a day were prescribed and the patient followed up at 2-weeks intervals. The lesions had cleared by the end of the second week and topical steroid treatment was stopped. Two months later, the patient presented with typical psoriatic skin lesions on her palms and soles. The results of the histopathological examination of the skin biopsy taken from the right palm were consistent with psoriasis. Psoriasis rarely involves the oral mucosa and is usually associated with cutaneous lesions. Oral lesions may present on the buccal mucosa, tongue, gingiva, palate, and very rarely the lips and ⁄ or perioral area. Because neither the clinical nor the histological changes are absolutely specific for psoriasis, particularly if cutaneous lesions are absent, diagnosis is difficult. Moreover, the existence of true psoriatic lesions of the oral mucosa is disputed. However, there is some agreement that oral psoriasis, although rare, does occur and the diagnosis is best made when the clinical course of the oral lesions parallels that of skin lesions and is supported by histological examination. Some additional criteria for the diagnosis of oral psoriasis such as a positive family history and human leucocyte antigen (HLA) typing have also been considered important in supporting a diagnosis of oral psoriasis. In our case, oral biopsy showed a psoriasiform pattern. Additionally, some features such as the chronicity and clinical appearance of the lesions characterized by silvery scales also suggested a diagnosis of isolated lip psoriasis. Weighing against this diagnosis were the absence of skin lesions, lack of a family history of psoriasis and the absence of HLA typing. Thus, although some criteria for the diagnosis of mucosal psoriasis have been suggested, diagnosis of isolated lip psoriasis was made only by the histopathological and clinical findings in our case. However, 2 months after the diagnosis, appearance of skin lesions with typical clinical and histopathological features of psoriasis confirmed the initial diagnosis. Lip psoriasis can be clinically confused with chelitis, chronic eczema, actinic dermatitis, chronic candidiasis and leucoplakia. In our case, these were not supported histologically. Most cases of oral psoriasis reported in the literature have been associated with skin disease and ⁄ or intraoral Figure 1 Mild erythema, adherent silvery scales and fissuring on lips. Viewpoints in dermatology • Correspondence

Expression of p53 in lesions and unaffected skin of patients with plaque-type and guttate psoriasis: A quantitative comparative study

Psoriasis is a common inflammatory and hyperproliferative skin disease characterized by hyperproliferation of keratinocytes. The pathogenesis of psoriasis has yet to be determined. The control of cell growth is a delicately balanced process, regulated by external signals or the internal genetic program of an individual cell. In psoriasis, these processes are disturbed and some candidate genes like p53 are suspected of being involved in the pathogenesis of the disease. The p53 protein is essential for the regulation of cell proliferation. The study was performed on 32 patients with psoriasis (24 plaque type, eight guttate type). Biopsy specimens for immunohistochemical determination of p53 protein expression were collected from both the lesional and the nonlesional skin sites that were not exposed to sun in all of the patients (n = 32). Taking the ultraviolet (UV) exposure of the skin into consideration, a third skin sample was taken from each patient (n = 7) who had lesions on the sun‐exposed areas. Immunohistochemical assessment of p53 expression in skin was determined as p53 protein expression per 1000 cells (keratinocytes). The statistical analysis revealed that the expressions of p53 per 1000 cells were higher in non‐sun‐exposed lesional skin than the non‐sun‐exposed nonlesional skin, also in plaque‐type psoriasis than guttate‐type psoriasis (P = 0.000, P = 0.046, P = 0.037, respectively). There was a positive correlation between the p53 expression in non‐sun‐exposed lesional skin versus expression in sun‐exposed lesional skin (cubic centimeters = 0.811, P = 0.027). Our results show a stronger association of elevated p53 expression with chronic rather than acute inflammatory psoriasis. This may indicate a mechanistic difference between plaque‐type and guttate psoriasis. Alternatively, this could reflect a chronological course as the disease transitions from an acute to a chronic phase.

Familial eruptive dermatofibromas in atopic dermatitis

Multiple eruptive dermatofibromas (MEDF) are rare and their aetiology is unknown. More than half of the patients with MEDF have underlying diseases, and more than 80% of the underlying diseases are immune mediated. Familial cases suggesting a genetic cause have also been reported. We report a case of familial eruptive dermatofibromas associated with atopic dermatitis, possibly caused by both hereditary factors and compromised immunity.

A simple open comedone extraction technique for Favre-Racouchot disease.

Favre–Racouchot disease (FRD) is a common disease characterized by solar elastosis and large open comedones and cysts. This disorder mainly affects elderly Caucasian men who have had a great deal of exposure to the sun. Patients having FRD continuously develop numerous large open comedones that could cause a cosmetic problem. We performed a simple and effective extraction technique for these open comedones using a standard dissecting forceps. This technique is well tolerated and no complications were observed. We suggest this comedone extraction technique as a simple alternative treatment for this common cosmetic problem.