Ching-Fu Huang

Exploring the link between cadmium and psoriasis in a nationally representative sample

Psoriasis, a skin inflammatory disease, originates from dysregulated interactions of the immune system. Cadmium, an environment pollutant, increases the levels of inflammation markers and influences the immune system. To clarify the relationship between cadmium and psoriasis, 5,927 participants, ≥20 years, in the National Health and Nutrition Examination Survey (NHANES) 2003–2006 were studied. Psoriasis severity was assessed using self-reported dermatology questionnaires. Cadmium was measured using blood chemistry. Three adjusted models were applied for the interaction between serum cadmium and severity of psoriasis. Psoriasis patients had significantly higher blood cadmium (0.67 vs. 0.52 μg/L, p = 0.006). There was a strong linear increase in predicted blood cadmium values with an increase in severity of psoriasis (p for trend = 0.002). The β coefficient of the predicted serum cadmium in the “few patches to extensive psoriasis” group was 0.234 (p = 0.002) after adjusting covariates. Participants with severe psoriasis have higher blood cadmium. Environmental exposure to cadmium can predispose to the worsening of psoriasis. Although there are still limitations in this study, such as not included treatment data, these results have substantial public health implications for the general population, as they demonstrate the importance of cadmium exposure prevention, particularly among psoriasis patients.

Wells’ syndrome associated with Churg–Strauss syndrome: correlation with mast cell distribution

Churg–Strauss syndrome (CSS) is an uncommon, autoimmune-mediated, multi-organ disease, cutaneous manifestations of which are diverse. Wells’ syndrome (WS) is an inflammatory dermatosis triggered by different factors and rarely occurs in CSS. Both CSS and WS are believed to represent allergic inflammatory responses in which cutaneous resident mast cells play a significant role. We report a 51-year-old woman who initially presented with bronchial asthma followed by recurrent erythematous wheals. The patient was finally diagnosed with WS associated with CSS and treated successfully with oral prednisolone. This case highlights the potential role of mast cells in the modulation of the allergic response in WS-associated CSS.

Sporotrichoid Chromoblastomycosis Successfully Treated by Combinative Therapy with Systemic Oral Antifungal Agent and Topical Cryotherapy

Chromoblastomycosis is a chronic persistent fungal infection which affects the skin and subcutaneous tissue. It is an occupation-associated fungal infection and exhibits a high prevalence rate in tropical and subtropical regions. Targeting the chronic progression of granulomatous inflammation, the single-treatment modality usually encounters difficulty and is accompanied by serious side effects. Herein we reported a patient who had multiple well-circumscribed erythmatous hypertrophic plaques with several satellite papules on the right elbow for 5 years and the diagnosis of chromoblastomycosis was confirmed by skin biopsy and fungal culture. The lesions were eradicated with the combined administration of oral itraconazole and liquid nitrogen cryotherapy for half a year. This case report is meant to suggest the use of combinative therapy for patients with intractable chromoblastomycotic infection.

Higher Platelet-to-Lymphocyte Ratio Increased the Risk of Sarcopenia in the Community-Dwelling Older Adults

The platelet-to-lymphocyte ratio (PLR) has been extensively studied in oncologic diseases. However, the correlation between PLR and sarcopenia remains unknown. In this cross-sectional analysis, we enrolled 3,671 non-institutionalized individuals from the National Health and Nutrition Examination Survey (NHANES) III (1988–1994) aged ≥60 years and whose complete blood counts (CBCs), body composition measurements, and related demographic information was available. Skeletal muscle mass was assessed using a previously published equation (including age, sex, height, and bioelectrical impedance analysis). PLR values were estimated based on laboratory data. Multiple linear and logistic regression analyses, quartile-based stratified odds ratio comparisons, and trend tests were performed. Elevations in serum PLR values were significantly associated with sarcopenia status and negatively associated with skeletal muscle index. After additionally adjusting for other covariates, the significant negative correlation remained; moreover, participants with highest serum PLR values (≥155) had 2.36 times greater risk of sarcopenia than those with lowest PLR values (<90; odds ratio (OR) = 2.36; 95% confidence interval (CI): 1.21–3.31; p < 0.01). Higher PLR levels are associated with a greater risk of sarcopenia in geriatric populations. Thus, PLR as an inexpensive and easily measurable parameter can be considered as an inflammatory biomarker for sarcopenia.

ALDH1A1 and ALDH3A1 Expression of Melanocytic Neoplasms and Associated with Clinicopathological Parameters in Chinese People

Background: ALDH1A1 and ALDH3A1 were reported to be highly expressed in some cancerous tissues. The aim of this study was to assess ALDH1A1 and ALDH3A1 expression and cellular localization in a spectrum of melanocytic lesions, ranging from common melanocytic nevi (CMN) and dysplastic nevi (DN) to acral melanoma (AM). We also compared the clinicopathological correlation of AM in a large Chinese population. Material and Methods: We used purified classspecific antibodies against ALDH1A1 and ALDH3A1 to elucidate the cellular distribution of these proteins in a human tissue microarray derived from 20 patients with CMN, 12 patients with DN, and 80 patients with primary acral MM. The cytoplasmic immunostaining score was obtained by multiplying the percentage of antigen-positive cells by their average immunostaining intensity. Mean ± S.E.M. for each experimental group was calculated and compared. The relationships between AJCC TNM stage and cytoplasmic scores of ALDH1A1 and ALDH3A1 were examined. Results: A statistically higher score for ALDH1A1 staining was noted in CMN than in DN (p＜0.028). ALDH3A1 staining was significantly different between CMN and AM. No statistical differences in survival and no association between cytoplasmic staining of both enzymes and other clinical parameters were demonstrated. Conclusion: ALDH1A1 and ALDH3A1 were differentially expressed in CMN, DN, and AM; yet, these enzymes may not be appropriate for use as prognostic factors.

Asymptomatic whitish papules over both arms in a 28‐year‐old woman

A 28-year-old woman presented with a 5-year history of asymptomatic lesions on her arms and upper back, which had been gradually increasing in number. The patient was otherwise healthy, and there was no history of previous trauma or preceding inflammatory dermatosis on the involved areas; however, no other medical records could be traced. On physical examination, numerous, round, white, asymptomatic, nonfollicular, papules measuring 1–2 mm in diameter were seen on the proximal surfaces of both arms and on the upper back (Fig. 1). These lesions were slightly indurated on palpation. Radiography of the patient’s right wrist did not show any abnormality. Histopathological findings