Francisco A. Tausk

Altered erythrocyte C3b receptor expression, immune complexes, and complement activation in homosexual men in varying risk groups for acquired immune deficiency syndrome.

We studied levels of erythrocyte C3b receptors (E-CR1) and correlated them to the level of circulating immune complexes (CIC) and complement activation in patients with or at risk for acquired immunodeficiency syndrome (AIDS). A significant reduction was found in patients with AIDS (185 +/- 93 CR1/cell), AIDS-related complex, and generalized lymphadenopathy, whereas healthy male homosexuals or normal controls had 434 +/- 193 and 509 +/- 140 CR1/cell, respectively (P less than 0.001). Family studies indicate that this defect is acquired. Reduction in E-CR1 was associated with increased levels of CIC when assayed by binding to Raji cells, but not when tested by C1q binding. Complement activation was assessed by levels of C3bi/C3d-g in plasma, measured with a monoclonal antibody specific for a neoantigen in C3d. AIDS patients had increased C3 activation (2.68 +/- 1.67%) when compared with normal controls (0.9 +/- 0.22%) (P less than 0.01). The decreased E-CR1, the presence of CIC, and C3 activation suggest that complement activation by immune complexes may play a role in the clinical expression of the disease.

Psoriasis, a model of dermatologic psychosomatic disease: psychiatric implications and treatments.

Psoriasis is a common dermatologic disorder with psychiatric comorbidity that often goes undetected and untreated. Psoriasis has higher associations with psychiatric illness than do other dermatologic conditions. We conducted a comprehensive qualitative review of all published medical literature on psoriasis and psychiatric comorbidities since 2005. We found that psoriasis patients suffer psychiatric and psychosocial morbidity that is not commensurate with the extent of cutaneous lesions. Biologic therapies and nonpharmacologic psychosocial interventions show promise in treating comorbid psychiatric illness. The main limitations of this review are the low quality of published studies and the infrequent use of basic science endpoints in reporting treatment outcomes. The literature examining the psychiatric comorbidity of psoriasis is expanding but remains of variable quality. Stronger studies will be necessary to more accurately estimate comorbidities and help identify and comprehensively treat suffering patients.

A Pilot Study of Hypnosis in the Treatment of Patients with Psoriasis

Background: The use of psychological therapies for patients with psoriasis has been proposed based on observations that the severity of their disease may correlate with emotional stress. The aim of this pilot study was to evaluate the effect of hypnosis as a treatment modality for patients with psoriasis. Methods: We performed a 3-month randomized, single-blind, controlled trial of the use of hypnosis in adults with stable, chronic, plaque-type psoriasis. Highly or moderately hypnotizable subjects were randomized to receive either hypnosis with active suggestions of improvement (5 patients) or neutral hypnosis with no mention of their disease process (6 patients). After this period, the study was unblinded, and all the patients were treated for an additional 3 months with hypnosis with active suggestions of improvement. Results: Highly hypnotizable subjects showed significantly greater improvement than did moderately hypnotizable subjects, independent of treatment group assignment (active suggestion or neutral hypnosis). Conclusion: Although this study included a very limited number of patients, the results suggest that hypnosis may be a useful therapeutic modality for highly hypnotizable subjects with psoriasis, and merits further testing in a larger patient population.

Cupping: East meets West

Cupping is the technique whereby a localized vacuum applied against the skin breaks superficial blood vessels in the papillary dermis, thereby creating distinctive circular cutaneous lesions. It is used mainly in Asia as an alternative therapy for a variety of ailments, and dermatologists, as skin specialists, should be able to recognize the unique morphology resulting from this procedure. Cupping can be accomplished by several techniques. Older methods employ the use of alcohol-soaked cotton at the base of brass, steel, or glass cups, which is subsequently lit on fire. 1

Use of complementary and alternative medicine among adults with skin disease: Updated results from a national survey

BACKGROUND Complementary and alternative medicine (CAM) is commonly used for a variety of diseases in the United States. Limited population-based data exist on CAM use among patients with dermatologic conditions OBJECTIVE We sought to determine the extent and the nature of CAM use in the United States among people with skin problems. METHODS We conducted a cross-sectional survey using the 2002 National Health Interview Survey and the Alternative Health Supplement. RESULTS Among those reporting skin problems in the past year, 49.4% (95% confidence interval 47.2-51.6) had used CAM. Only 6.0% of this group (95% confidence interval 4.2-7.7) used CAM specifically for skin disease. Those reporting skin problems were more likely to use CAM than those who did not report skin problems (odds ratio 1.7, P < or = .001, 95% confidence interval 1.6-1.8). The most commonly used CAM modality was nonvitamin, nonmineral, natural products (ie, herbals). LIMITATIONS Because of the nature of a cross-sectional study, it is not possible to know whether the skin problem or the CAM use came first (except in situations where they used CAM specifically for skin problems). Because this is not a dermatology-focused database, the definition of skin disease is vague. CONCLUSION CAM use among adults with skin problems in the Unites States is common. Dermatologists should have candid discussions with their patients regarding CAM use.

Complementary and alternative medicine for psoriasis: A qualitative review of the clinical trial literature

BACKGROUND Patients with psoriasis often inquire about complementary and alternative medicine in an effort to do everything possible to control the disease. OBJECTIVE We sought to review the clinical trial literature regarding complementary and alternative medicine for the treatment of psoriasis. METHODS We conducted qualitative systematic review of randomized, clinical trials. RESULTS Although many randomized controlled trials were found, both the results and the quality of the studies varied. LIMITATIONS The main limitations were the relatively low quality of studies (as assessed by Jadad scores), lack of inclusion of unpublished studies, and the fact that only one author determined inclusion of studies and assignment of Jadad scores. CONCLUSION There is a large body of literature in regard to complementary and alternative medicine for the treatment of psoriasis. More work is necessary before these modalities should be recommended to our patients.

A medical conundrum: onset of psoriasis in patients receiving anti-tumour necrosis factor agents

Life is a paradox. Every truth has its counterpart which contradicts it, and every philosopher supplies the logic for his own undoing. Elbert Hubbard In the past decade, tumour necrosis factor (TNF) antagonists have been found to be remarkably effective for the treatment of immune-mediated inflammatory disorders such as rheumatoid arthritis and Crohn’s disease.1 These agents also dramatically lessen inflammation and improve the quality of life in patients with psoriasis and psoriatic arthritis.2 The TNF-blocking agents have been relatively safe, although some concerns have been raised on the basis of a recent meta-analysis of trial data that identified an increased risk of serious infections and solid malignancy in a small percentage of patients treated with anti-TNF antibodies.3 Of late, attention has also focused on a wide spectrum of skin lesions arising in patients treated with TNF antagonists.4 The list is quite extensive, but some of the more common dermatological conditions include skin infections, skin tumours, discoid lupus, eczema, vasculitis and drug-related eruptions. Perhaps one of the most perplexing lesions are the psoriasiform eruptions that have been described in patients with rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel disease and Behcet’s disease during anti-TNF treatment, particularly because TNF is a pivotal molecule in the pathophysiology of psoriatic skin lesions.5 To date, 30 cases of psoriasiform skin eruptions have been reported in patients receiving TNF antagonists.6,7,8,9,10,11,12 Table 1 summarises the demographics and information regarding diagnosis, type of TNF antagonist and details of the appearance and resolution of the skin lesions. Most of the patients had underlying rheumatoid arthritis, although this may simply reflect the fact that more patients with this diagnosis receive treatment with anti-TNF agents. Eight patients were receiving treatment for ankylosing spondylitis, two had inflammatory bowel disease and two …

Rapid Increases in Peptide Processing Enzyme Expression in Hippocampal Neurons

Abstract: Recent studies have demonstrated that seizure activity causes a dramatic increase in neuropeptide expression in specific regions of the rat hippocampus. In this study we investigated the effect of electroconvulsive treatment (ECT) on the expression of three posttranslational processing enzymes involved in the production of many bioactive peptides from their inactive precursors. Peptidylglycine α‐amidating monooxygenase (PAM) converts peptidylglycine substrates into α‐amidated products and prohormone convertases 1 and 2 perform the tissue‐specific endoproteolytic cleavage of many prohormones. After a single ECT, in situ hybridization demonstrated a rapid increase in the level of PAM mRNA in the dentate granule cells of the hippocampus, reaching peak levels between 1 and 4 h and then returning to near baseline levels within 24 h. Northern blot analysis confirmed the changes in PAM mRNA expression seen by using in situ hybridization. Similar rapid changes in PAM mRNA expression were seen after repeated ECT, suggesting that chronic ECT did not affect the regulation of PAM expression in the hippocampus. Immunohistochemical staining demonstrated an increase in PAM protein in the molecular layer of the dentate gyrus at 4 and 8 h after a single ECT. Based on in situ hybridization, levels of mRNA for the prohormone convertases 1 and 2 were also increased in dentate granule cells after a single ECT. Prohormone convertase 2 mRNA levels exhibited a slower response to ECT, not reaching maximal levels until 8 h after ECT. The response of the dentate granule cells of the hippocampus to ECT provides a model system for studying the rapid, coordinate regulation of peptide‐processing enzymes.

Mycobacterium marinum with different responses to second-generation tetracyclines

Background  Persistent cutaneous infections with Mycobacterium marinum can follow exposure of injured skin to contaminated water or fish, and can be treated with second‐generation tetracyclines in addition to other antimicrobials. Due to the rarity of this infection, there are few data comparing the different treatment alternatives.

Exogenous but not endogenous substance P releases histamine from isolated human skin fragments

Neuropeptides such as substance P are released from nerve terminals following the stimulation of sensory fibers, and are thought to participate in neurogenic inflammation in the skin; it is often speculated that mast cell activation is an intermediate step in this process. In the present study we addressed this hypothesis using freshly obtained skin explants derived from human neonatal foreskins or adult skin resections. The results demonstrate that when substance P is released from human skin by incubation in the presence of capsaicin (10(-5)M), no histamine is released from human isolated skin fragments. In each experiment human recombinant stem cell factor and/or exogenously applied substance P effectively evoked histamine release from the explants, attesting to the viability of the mast cells in the preparation. The concentrations of exogenously applied substance P required to elicit histamine release, however, were large (> 10 microM). These results indicate that substance P released from cutaneous sensory nerve fibers does not reach sufficient concentrations in the skin to degranulate mast cells. These data support the hypothesis that the vascular effects of neurogenic inflammation occur independently of mast cell activation.