Miquel Ribera

Effect of smoking on skin elastic fibres: morphometric and immunohistochemical analysis

Background  It has been established during recent years that smoking is an independent risk factor for the development of premature facial wrinkling. The underlying mechanism is not well known, but elastic fibres of the dermis seem to be the major target of smoke components.

Sequential combined therapy with thalidomide and narrow-band (TL01) UVB in the treatment of prurigo nodularis.

BACKGROUND Prurigo nodularis (PN) is a chronic disease of which treatment choices are limited. Among them, thalidomide and phototherapy have been used with satisfactory results. Unfortunately, the possibility of side effects limits their use. OBJECTIVE To evaluate the efficacy of a sequential combined treatment with thalidomide and ultraviolet B (UVB) therapy in order to minimize side effects and, thus, making possible a long-term treatment. METHODS A prospective open trial combining thalidomide as initial therapy followed by narrow-band UVB (TL01) irradiation until complete or almost complete remission of the disease was achieved. RESULTS An excellent response was obtained after an average of 12 weeks of thalidomide therapy and 32 UVB courses. CONCLUSIONS Sequential combined therapy with thalidomide and narrow-band UVB therapy could improve the management of prurigo nodularis with minimal side effects, although it should probably be reserved to men and women over 50 years of age.

Sterile Transient Neonatal Pustulosis Is a Precocious Form of Erythema toxicum neonatorum

A sterile pustular skin eruption was observed in 17 of 3,541 newborn infants examined over a period of 30 months. The skin eruption was always present at birth and fulfilled the clinical criteria of transient neonatal pustular melanosis (TNPM). However, some days after birth, all of them but 1 developed skin lesions typical of erythema toxicum neonatorum (ETN). Histological examination of 11 biopsies obtained at the age of 1 day showed intracorneal neutrophilic pustules in 4 and subcorneal intraepidermic eosinophilic pustules in 7. On the basis of our findings and a literature review we consider that a clear-cut differentiation between TNPM and ETN is not always possible. We propose the name sterile transient neonatal pustulosis to unify these conditions.

Circulating levels of lipocalin-2 and retinol-binding protein-4 are increased in psoriatic patients and correlated with baseline PASI

Psoriasis has been related to metabolic syndrome (MS). Adipocytokines produced by white adipose tissue may be involved in the pathogenesis of psoriasis and its association with MS. Our objectives were to characterize the profile of a number of different inflammatory and atherogenic markers, vitamins, adipokines and cytokines and their potential involvement in MS in patients with moderate-to-severe psoriasis without joint involvement compared to anthropometrically matched controls, and to evaluate correlation with severity of the skin disease and changes after narrow-band UVB (NB-UVB) phototherapy. We designed a prospective cross-sectional study. Baseline waist circumference, body fat composition, lipid, carbohydrate and calcium metabolism profile, inflammation markers, homocysteine and vitamins D, B6, B12 and folic acid, leptin, resistin, omentin, lipocalin-2, adipocyte fatty acid-binding protein, retinol-binding protein-4 (RBP-4), interleukin-6, soluble tumour necrosis factor receptor 1 (sTNFR1) and interleukin-17 of 50 psoriasis patients and 50 gender, age and body mass index-matched controls were recorded, then evaluated after NB-UVB in the patients. The patients had higher baseline serum concentrations of leptin, RBP-4, lipocalin-2 and sTNFR1. Baseline psoriasis area and severity index correlated with serum concentrations of RBP-4 and lipocalin-2 only. Principal components analysis disclosed a component including vitamins B12, B6, folic acid, calcidiol and HDL-cholesterol that was only present in healthy controls and opposed to a cluster of variables which promote MS. This component was absent in the patients. Our results point to lipocalin-2 and RBP-4 as relevant mediators of the trend towards MS in psoriatic patients.

Spanish Evidence-Based Guidelines on the Treatment of Psoriasis With Biologic Agents, 2013. Part 1: On Efficacy and Choice of Treatment

Biologic therapy is a well-established strategy for managing moderate and severe psoriasis. Nevertheless, the high cost of such therapy, the relatively short span of clinical experience with biologics, and the abundance of literature now available on these agents have made evidence-based and consensus-based clinical guidelines necessary. The ideal goal of psoriasis treatment is to achieve complete or nearly complete clearing of lesions and to maintain it over time. Failing that ideal, the goal would be to reduce involvement to localized lesions that can be controlled with topical therapy. Although current evidence allows us to directly or indirectly compare the efficacy or risk of primary or secondary failure of available biologics based on objective outcomes, clinical trial findings cannot be directly translated to routine practice. As a result, the prescribing physician must tailor the treatment regimen to the individual patient. This update of the clinical practice guidelines issued by the Spanish Academy of Dermatology and Venereology (AEDV) on biologic therapy for psoriasis incorporates information from the most recent publications on this topic.

Effect of narrowband ultraviolet B therapy on inflammatory markers and body fat composition in moderate to severe psoriasis

Background  Previous studies have shown increased prevalence of metabolic syndrome in patients with psoriasis.

Erythroderma due to Thalidomide: Report of Two Cases

Cutaneous reactions to thalidomide therapy are reported infrequently. We report two new cases. Both patients suffered from chronic renal insufficiency and were on thalidomide therapy because of prurigo nodularis. The cutaneous reaction consisted of a severe erythematous rash progressing to erythroderma, associated with peripheral eosinophilia. In both cases rapid resolution occurred after withdrawal of thalidomide. We emphasize the possibility of a severe cutaneous hypersensitivity reaction due to thalidomide and speculate about the role played by the renal insufficiency present in both cases.

Relationships between lung function, smoking and morphology of dermal elastic fibres.

Objective:  To investigate the relationship between lung function and dermal elastic fibres in non‐smokers and smokers with and without chronic obstructive pulmonary disease (COPD).

DIDEOXYINOSINE-ASSOCIATED OFUJI PAPULOERYTHRODERMA IN AN HIV-INFECTED PATIENT

Ofuji papuloerythroderma Human immunodeficiency virus Dideoxyinosine Dr. Carlos Ferrándiz, Department of Dermatology, Hospital Universitari Germans Trias i, Pujol, Crta. de Canyet, s/n, E– 08916 Badalona (Spain), Tel. 03 3 465 12 00 (ext. 324), Fax 03 3 395 42 05 Ofuji papuloerythroderma (OPE) is characterized by a widespread pruritic eruption of fixed erythematous papules producing an erythro-derma appearance [1]. A relationship to malignancies and infections has been reported [2, 3], We report a young patient with AIDS who developed – after starting treatment with dideoxyinosine (DDI) – a widespread cutaneous eruption consistent with the diagnosis of OPE. A 31-year-old man presented with a 10-month history of an itching skin eruption. He had been seropositive for human immunodeficiency virus (HIV-1) and chronic hepatitis C virus 4 years before. Since then, the patient has been on dapsone, pyrimethamine and folinic acid treatment. One month before the onset of the rash, treatment with 2’,3’-DDI, 200 mg/l2 h, had been introduced. The rash began symmetrically with erythema and hyperkeratosis on the palms and soles. Five months later, an erythematous rash with pruritic red flat papules appeared on the trunk, which spread progressively over the entire skin surface sparing the head, flexures and body folds, giving to the skin a cobblestone appearance. The mucous membranes were uninvolved. There were some palpable axillar and inguinal lymph nodes. A routine full blood count was normal, except for a lymphopenia with 0.040 × 109 CD4/1, without eosinophilia or abnormal titers of IgE; liver and kidney function tests were also normal. Chest X-ray, total-body bone scanning and bone marrow biopsy showed no abnormalities. A computed tomography scan of the chest and abdomen showed enlarged axillar, inguinal, paraaortic and infrarenal lymph nodes, and hepatosplenomegaly. Histologic examination of a flat papule revealed granulomatous dermatitis with a perivascular and periadnexal lym-phohistiocytic infiltrate (CDS) with eosinophils and occasional multi-nucleated giant cells and Langerhans cells. ß-TCR gene rearrangement studies did not show monoclonality proliferation. Histology of an inguinal lymph node showed dermatopathic lymphadenitis. Treatment with DDI was stopped, and after 2 months of PUVA

Lipopolysaccharide-binding protein is increased in patients with psoriasis with metabolic syndrome, and correlates with C-reactive protein.

Lipopolysaccharide‐binding protein (LBP) is a reliable indicator of serum lipopolysaccharide (LPS) concentration. Raised levels of circulating LPS can trigger an increase in chronic pro‐inflammatory cytokines, which may mediate the development of insulin resistance and obesity. Psoriasis is a chronic inflammatory skin disease that has been associated with metabolic syndrome. We aimed to study the expression of LBP in patients with psoriasis treated with narrowband ultraviolet B phototherapy, and controls matched by age, gender and body mass index (BMI). We did not find any differences in serum LBP concentration between patients and controls, and serum LBP did not correlate with the Psoriasis Area and Severity Index. However, patients with psoriasis and metabolic syndrome had higher serum concentration of LBP than controls. Furthermore, correlation with BMI and apolipoprotein B was present in controls, but not in patients with psoriasis. Serum LBP level did not change significantly after treatment with phototherapy.