Mette Gyldenløve

MicroRNA-223 and miR-143 are important systemic biomarkers for disease activity in psoriasis.

BACKGROUND Psoriasis is a systemic inflammatory skin disease. MicroRNAs (miRNAs) are a class of small non-coding RNA molecules that recently have been found in the blood to be relevant as disease biomarkers. OBJECTIVE We aimed to explore miRNAs potential as blood biomarkers for psoriasis. METHODS Using microarray and quantitative real-time PCR we measured the global miRNA expression in whole blood, plasma and peripheral blood mononuclear cells (PBMCs) from patients with psoriasis and healthy controls. RESULTS We identified several deregulated miRNAs in the blood from patients with psoriasis including miR-223 and miR-143 which were found to be significantly upregulated in the PBMCs from patients with psoriasis compared with healthy controls (FCH=1.63, P<0.01; FCH=2.18, P<0.01, respectively). In addition, miR-223 and miR-143 significantly correlated with the PASIscore (r=0.46, P<0.05; r=0.55, P<0.02, respectively). Receiver-operating characteristic analysis (ROC) showed that miR-223 and -143 have the potential to distinguish between psoriasis and healthy controls (miR-223: area under the curve (AUC)=0.80, miR-143: AUC=0.75). Interestingly, after 3-5 weeks of treatment with methotrexate following a significant decrease in psoriasis severity, miR-223 and miR-143 were significantly downregulated in the PBMCs from patients with psoriasis. CONCLUSION We suggest that changes in the miR-223 and miR-143 expressions in PBMCs from patients with psoriasis may serve as novel biomarkers for disease activity in psoriasis; however, further investigations are warranted to clarify their specific roles.

Eucalyptus contact allergy

Although most plants are harmless to the skin, allergic reactions to flora are occasionally seen in dermatology practice. Allergic contact dermatitis caused by plants can occur following airborne exposure to pollen, or after prolonged or repeated contact with the stem, leaves, or sap. Also, patients may react to organisms living on the plant, as the cure for allergic contact dermatitis is avoidance of the offending substance, the culprit allergen should be identified. We present a rare case of allergic contact dermatitis caused by the eucalyptus plant.

Increased expression of glucagon-like peptide-1 receptors in psoriasis plaques.

Recent case reports suggest that treatment with glucagon‐like peptide‐1 (GLP‐1) agonists results in clinical improvement of psoriasis. The purpose of this study was to determine whether GLP‐1 receptors (GLP‐1Rs) are found in the skin of healthy volunteers and psoriasis patients and if so, whether GLP‐1Rs are located on keratinocytes or immune cells.

Severe hypercalcaemia, nephrocalcinosis, and multiple paraffinomas caused by paraffin oil injections in a young bodybuilder

A 23-year-old bodybuilder presented in August, 2013, with a 24 h history of scrotal pain. Swabs for infection, and abdominal CT scan for nephrolithiasis, were negative, but blood tests showed anaemia, renal insuffi ciency, and severe hypercalcaemia (free calcium 2·29 mmol/L, normal: 1·18–1·32 mmol/L). C-reactive protein was normal. He had suppressed parathyroid hormone, raised angiotensin-converting enzyme and interleukin receptor levels, low 25-hydroxyvitamin D, and high 1,25-dihydroxyvitamin D. Physical examination revealed many warm, dense nodules in the skin and subcutaneous tissue overlying the pectoral, trapezius, and biceps muscles. For cosmetic reasons, he had injected paraffi n oil into his chest, arms, and back for the past 3 years. After the last injection, 6 months previously, he had developed local infl ammation, treated with oral antibiotics twice, but he felt ongoing discomfort, and reported diffi culties breathing, associated with a tightening in the chest and neck. He had also been taking non-prescribed vitamin D, unspecifi ed dietary supplements, and anabolic steroids. A PET-CT scan showed increased metabolic activity in the subcutis of the anterior thorax and upper arms (fi gure). There were no signs of sarcoidosis. Skin punch biopsies showed paraffi nomas with vacuoles and a chronic, non-necrotising infl ammatory response, and immuno histochemical staining showed high expression of CYP27B1 (appendix). PCR for bacteria was negative. Pulmonary examinations showed diff use pulmonary infi ltration, segmental perfusion defects, reduced diff usion capacity, lipoid pneumonia, and foreign-body infl ammatory reaction (appendix). Tuberculosis microscopy and culture were negative. A kidney biopsy showed pronounced nephrocalcinosis (appendix). We treated the patient with intravenous fl uid infusion, diuretics, and pamidronate, and after the PET-CT with prednisolone 40 mg, moxifl oxacin 400 mg, and azithromycin 1000 mg daily. Despite poor adherence, at last follow-up in October, 2013, his calcium and creatinine had almost returned to normal, and skin infl ammation was substantially decreased. Complications of subcutaneous paraffi n oil injection have been known since the 19th century, but bodybuilders still use the technique to enhance muscle contouring. It causes acute local infl ammation usually followed by a latent phase. Dependent on the volume injected and potential contamination, chronic foreign-body granulomas may form, appearing as dense nodules with occasional ulceration or fi stulas secreting oily materials. Our patient developed paraffi nomas, which contributed to severe hypercalcaemia resulting in nephrocalcinosis and reduced renal function. Paraffi n oil migration caused respiratory problems. The initial scrotal pain, which did not recur, might have been caused by ureteral colic. Hypercalcaemia is common, usually caused by hyperparathyroidism, malignancy, or sarcoidosis, and can be life-threatening. Granulomatous foreign-body reactions are a rare but important diff erential diagnosis. Calcium is normally tightly regulated by parathyroid hormones and vitamin D, which is converted to the active form, 1,25-dihydroxyvitamin D (calcitriol), by CYP27B1. In granuloma-induced hyper calcaemia, as in our patient, calcitriol production is catalysed by abnormal activity of CYP27B1 in infl ammatory cells, particularly macro phages. This extrarenal activity does not appear to be regulated by classic feedback mechanisms, allowing calcitriol (and calcium ions) to rise to pathological levels.

Distinguishing hyperhidrosis and normal physiological sweat production: new data and review of hyperhidrosis data for 1980-2013.

Hyperhidrosis is a condition in which the production of sweat is abnormally increased. No objective criteria for the diagnosis of hyperhidrosis exist, mainly because reference intervals for normal physiological sweat production at rest are unknown.

Lack of effect of the glucagon-like peptide-1 receptor agonist liraglutide on psoriasis in glucose-tolerant patients – a randomized placebo-controlled trial

It has been proposed that glucagon‐like peptide‐1 receptor (GLP‐1R) agonists used for the treatment of patients with type 2 diabetes might also improve their psoriasis.

'Short-term treatment with methotrexate does not affect microvascular endothelial function in patients with psoriasis'

Psoriasis is associated with increased risk of cardiovascular disease (CVD), possibly due to chronic low‐grade systemic inflammation. Systemic anti‐inflammatory treatment might reduce the risk of CVD.

Impaired incretin effect is an early sign of glucose dysmetabolism in nondiabetic patients with psoriasis.

Patients with psoriasis have an increased risk of type 2 diabetes. The gastrointestinal system plays a major role in normal glucose metabolism, and in healthy individuals, postprandial insulin secretion is largely mediated by the gut incretin hormones. This potentiation is termed the incretin effect and is reduced in type 2 diabetes. The impact of psoriasis on gastrointestinal factors involved in glucose metabolism has not previously been examined.

Drug concentration and antidrug antibodies in patients with psoriasis treated with adalimumab or etanercept

Tumour necrosis factor (TNF)-α antagonists are used for treatment of psoriasis and are generally effective and well tolerated (1,2). However, a substantial proportion of patients lose effect over time. The underlying mechanisms are unclear, but data suggest that formation of anti-drug antibodies leads to sub-therapeutic drug levels and thereby loss of efficacy (3). This article is protected by copyright. All rights reserved.

Validation of psoriasis severity classification based on use of topical or systemic treatment

In recent years, population-based studies have reported a considerable burden of disease among patients with psoriasis. Cumulative epidemiological data suggests that patients with psoriasis have an increased incidence and prevalence of cardio-metabolic comorbidities and a disease-severity dependent relationship is often reported. An accepted classification system is the Psoriasis Area and Severity Index (PASI), where one proposed categorization suggests that a score of less than 7 as mild, a score between 7 and 12 is moderate, and a score greater than 12 is consistent with severe psoriasis. This article is protected by copyright. All rights reserved.