Lyubomir A. Dourmishev

Molecular Genetics of Kaposi's Sarcoma-Associated Herpesvirus (Human Herpesvirus 8) Epidemiology and Pathogenesis

SUMMARY Kaposis sarcoma had been recognized as unique human cancer for a century before it manifested as an AIDS-defining illness with a suspected infectious etiology. The discovery of Kaposis sarcoma-associated herpesvirus (KSHV), also known as human herpesvirus-8, in 1994 by using representational difference analysis, a subtractive method previously employed for cloning differences in human genomic DNA, was a fitting harbinger for the powerful bioinformatic approaches since employed to understand its pathogenesis in KS. Indeed, the discovery of KSHV was rapidly followed by publication of its complete sequence, which revealed that the virus had coopted a wide armamentarium of human genes; in the short time since then, the functions of many of these viral gene variants in cell growth control, signaling apoptosis, angiogenesis, and immunomodulation have been characterized. This critical literature review explores the pathogenic potential of these genes within the framework of current knowledge of the basic herpesvirology of KSHV, including the relationships between viral genotypic variation and the four clinicoepidemiologic forms of Kaposis sarcoma, current viral detection methods and their utility, primary infection by KSHV, tissue culture and animal models of latent- and lytic-cycle gene expression and pathogenesis, and viral reactivation from latency. Recent advances in models of de novo endothelial infection, microarray analyses of the host response to infection, receptor identification, and cloning of full-length, infectious KSHV genomic DNA promise to reveal key molecular mechanisms of the candidate pathogeneic genes when expressed in the context of viral infection.

Efficacy and tolerance of oral ivermectin in scabies

Objective The aim of this open‐label study was to investigate the therapeutic effect and adverse reactions of oral ivermectin in scabies patients.

Activity of certain drugs in inducing of inflammatory myopathies with cutaneous manifestations

Background: At present, the pharmacological activity of drugs in inducing of inflammatory myopathies is not a solved problem. Objective: Analysis of the adverse reaction of drugs show that in both adults and children they can cause clinical manifestations of dermatomyositis and its variants [classic, juvenile, paraneoplastic or amyopathic], polymyositis and its variants [eosinophilic myositis, overalp syndrome], or other conditions such as eosinophilia myalgia syndrome, and eosinophilic fasciitis. Methods: Literature databases were analyzed and combined with personal experience to identify drug activity associated with dermatomyositis and its variants. Conclusion: Lipid-lowering agents, anti-infectious, NSAIDs, antineoplastic medicines, other non-related drugs, vaccines, and over the counter essential amino acids such as L-tryptophan are of particular interest in the induction of myositis, or myalgia and cutaneous features of idiopathic inflammatory myopathies. Clinical manifestations and various pathogenetic mechanisms leading to injury of muscles and skin from medicines in this illness are presented and analyzed.

Segmental ulcerative vasculitis: a cutaneous manifestation of Takayasu's arteritis

A 16‐year‐old girl with pyoderma gangrenosum (PG)‐like skin lesions on the extremities, trunk and face developed Takayasus arteritis (TA; pulseless disease). After 3 years under maintenance cyclosporin A therapy, the patient developed an ischaemic cerebral accident. Severe obstruction of both subclavian and left carotid arteries was found by Doppler sonography, angiography and computerised axial tomography. Evolution of this disease showed some characteristic findings: (a) PG‐like lesions as the first cutaneous manifestation of pulseless disease; (b) methotrexate and cyclosporin A giving good results for the cutaneous lesions, but apparently not exerting an influence on the evolution of TA and the fatal outcome. This morphologic pattern may reflect underlying TA or Wegeners arteritis, and should be termed segmental ulcerative vasculitis.

Intravenous Immunoglobulins: Mode of Action and Indications in Autoimmune and Inflammatory Dermatoses

Intravenous immunoglobulins (IVIGs), a mixture of variable amounts of proteins (albumin, IgG, IgM, IgA, and IgE antibodies), as well as salt, sugar, solvents, and detergents, are successfully used to treat a variety of dermatological disorders. For decades, IVIGs have been administered for treatment of infectious diseases and immune deficiencies, since they contain natural antibodies that represent a first-line defense against pathogens. Today their indication has expanded, including the off-label therapy for a variety of autoimmune and inflammatory diseases. In dermatology, IVIGs are administered for treatment of different disorders at different therapeutic regimens, mostly with higher doses then those administered for treatment of infectious diseases. The aim of this prospective review is to highlight the indications, effectiveness, side effects, and perspectives of the systemic treatment with IVIGs for patients with severe, life-threatening, and resistant to conventional therapies autoimmune or inflammatory dermatoses.

Perforating Disseminated Necrobiosis Lipoidica Diabeticorum

Perforating necrobiosis lipoidica is a very rare clinical variant which consists of degeneration and transepidermal elimination of the collagen with few cases reported in the literature. In two-thirds of the patients it associates with diabetes, with no relation with the glucose control. We present a 42-year-old female patient with a 7-year history of diabetes on insulin therapy, referred to our clinic with a 3-year history of multiple asymptomatic firm plaques disseminated on the upper and lower extremities. The clinical and histological findings proved the diagnosis of perforating necrobiosis lipoidica.