Sirje Kaur

Clear differences in adiponectin level and glutathione redox status revealed in obese and normal-weight patients with psoriasis

Background  Several studies have shown increased prevalence of obesity in patients with psoriasis.

The levels of adiponectin and leptin and their relation to other markers of cardiovascular risk in patients with psoriasis

Background  A link between psoriasis and risk for cardiovascular disease (CVD) is supposed. Adipokines (adiponectin and leptin) playing roles in inflammation as well as lipid metabolism could have impact on CVD.

Successful management of mild atopic dermatitis in adults with probiotics and emollients

Atopic dermatitis is characterized by impaired skin and mucous membrane barrier function. Measures improving barrier integrity decrease the influence of environmental factors that might exacerbate inflammation. Ten adult patients with mild-to-moderate atopic dermatitis consumed for three months fermented with potent antioxidative probiotic, L. fermentum ME-3 (DSM 14241) goat milk 200 mg/day. A control group consisted of six patients, not supplemented by probiotic. All patients used emollients regularly. Skin iron levels, glutathione redox ratios (GSSG/GSH), diene conjugate (DC) amounts, blood glutathione status, oxidized low-density lipoprotein (oxLDL), and total antioxidativity was measured at the baseline and after three months. A significant decrease in skin iron levels, DC amounts, and glutathione redox ratio occurred in the probiotic-supplemented group compared to the control group (P < 0.05 for all indices). In the same group, blood levels of oxLDL decreased (p < 0.05), and GSH levels increased (P < 0.001) with concomitant improvement in the GSSG/GSH ratio. Blood antioxidativity markers also showed an improvement. The results of our study demonstrate that regular use of probiotics with antioxidative properties coupled with the use of lipid-containing emollients considerably decreases inflammation and concomitant oxidative stress in adult patients with mild-to-moderate atopic dermatitis. This effect was observed both in the skin and in the blood.

Nickel sulphate and epoxy resin: differences in iron status and glutathione redox ratio at the time of patch testing

The reactive patch test reaction is a useful model to characterize oxidative stress in acute allergic contact dermatitis. This model was used to study oxidative stress in the skin of individuals allergic to nickel and epoxy resin. The study included six and five patients, respectively, whose skin was simultaneously biopsied from a positive patch test site and from an apparently healthy area. The biopsies were homogenized and used for determination of iron content, unbound iron binding capacity, diene conjugate levels, and glutathione redox ratio. A positive test reaction to 5% nickel sulphate was accompanied by 2.5-fold increase in iron level as compared to apparently healthy skin (P<0.1). The percentage saturation of iron-binding capacity and the glutathione redox ratio were significantly increased (P<0.01 and P<0.05, respectively). Reactive patch test responses to 1% epoxy resin were not accompanied by clear alterations in iron status or glutathione redox ratio. Our investigation showed that apart from oxidative burst caused by accumulation of inflammatory cells, hapten properties might also influence the oxidative stress status of the skin. The high incidence of nickel allergy may be attributed, at least in part, to the influence of nickel ions on the glutathione redox ratio and iron status of the skin.

Allergic Contact Dermatitis Is Associated with Significant Oxidative Stress

Background. Research has confirmed the involvement of oxidative stress (OxS) in allergic contact dermatitis whilst other inflammation-related biomarkers have been less studied. Objective. To evaluate systemic levels of selected inflammatory markers, OxS indices and adipokines as well as their associations in allergic contact dermatitis. Methods. In 40 patients, interleukin- (IL-) 6, monocyte chemoattractant protein (MCP-1), and IL-10 levels were measured in sera with the Evidence Investigator Cytokine & Growth factors High-Sensitivity Array, total peroxide concentration (TPX) and total antioxidant capacity (TAC) by means of spectrophotometry, and the plasma concentrations of adiponectin and leptin by the quantitative sandwich enzyme immunoassay technique. Results. TNF-α level (P < 0.01) and TPX (P < 0.0001) were increased whilst IL-10 (P < 0.05) and TAC (P < 0.0001) were decreased in the patients as compared to controls. Correlation and multiple linear regression analysis identified both, TPX and TAC (inversely), as possible independent markers for evaluating allergic contact dermatitis. Adiponectin level in patients was increased (P < 0.0001), but neither adiponectin nor leptin correlated significantly with the biomarkers of inflammation or OxS. Conclusion. OxS parameters, especially TPX and OSI, reflect the degree of systemic inflammation associated with allergic contact dermatitis in the best way. The relation between OxS and adiponectin level warrants further studies.

Cogent differences in skin heme oxygenase‐1 levels between psoriasis patients and healthy controls

© 2008 The Authors JEADV 2009, 23, 70–110 Journal compilation

Emollient cream and topical glucocorticoid treatment of chronic hand dermatitis: influence on oxidative stress status of the skin

To the Editor Exacerbation of skin inflammation is accompanied by excessive production of reactive oxygen species (ROS) like superoxide (O2 + ) and hydroxyl radical (OH+) [1]. Besides damaging lipids, proteins and nucleic acids [2], some of ROS (e.g. superoxide anion) are capable of reducing transition metal ions, releasing iron from storage proteins, e.g. ferritin [1]. Excess of ‘free’ iron amplifies the formation of free radicals, especially those involved in lipid peroxidation (LP) [3]. Inside the cells, ROS are detoxified primarily by reduced glutathione (GSH) [4]. Removal of peroxides by this antioxidant results in generation of oxidized glutathione (GSSG) [5]. Therefore, the cellular redox status is best characterized by the glutathione redox ratio (GSSG/GSH). The aim of our study was to determine how different treatment regimes influence the iron status, diene conjugate amount, and glutathione redox ratio in lesional skin of patients with exacerbated chronic hand dermatitis. The study, approved by the local ethics committee, included twelve patients (11 women and a man, aged 21 /63). Skin punch biopsies of 4 mm were obtained from involved hand skin and apparently healthy skin from the back prior to the study, and an additional biopsy was obtained from treated hand skin. Four healthy subjects’ skin (a man, and three women, aged 22 /35) was also biopsied for comparison of skin iron levels. One six-patient group was treated with Locobase† REPAIR cream 4 /6 times/day, another with Fucicort cream (betamethasonum 0.1%, acidum fusidicum 2%) twice a day in combination with the emollient Locobase† fatty cream 4 /6 times/day. The treatment period lasted from 6 to 10 weeks until improvement. Biopsies were homogenized and used for assays. For determination of iron content and unsaturated iron binding capacity (UIBC) the Sigma 565 kit was used [6]. Total iron binding capacity (TIBC) was calculated as the sum of iron and UIBC values. The level of diene conjugates (DC) was determined as previously described [7]. Glutathione was measured by the method described earlier [8]. The glutathione redox ratio was expressed as GSSG/ GSH. Before treatment, the iron level in lesional skin of all 12 patients as compared to apparently healthy skin (5859/736 and 4059/446 mM/g skin, respectively) was non-significantly, DC level significantly (6609/282 and 3349/174 mM/g skin, P / 0.002), and GSSG/GSH also significantly (0.409/ 0.19 and 0.189/0.11, P /0.002) increased. UIBC and TIBC values did not differ. After therapy, glutathione redox ratio decreased significantly (P /0.0002) while iron and DC levels in lesional skin remained high as compared to clinically undamaged skin. The patients’ normal skin demonstrated approximately 2.5 times higher iron concentration than healthy individuals’ skin. As shown in Fig. 1, both selected treatment regimes equally improved the GSSG/GSH ratio but neither of them affected the iron level. Although our investigation included a limited number of patients, we can assume that more intensive LP in the lesions of chronic hand dermatitis is due to ‘free’ iron as in patients’ skin the iron level was 2.5 times higher than in healthy control subjects. Furthermore, the iron level in normal skin was significantly associated with disease duration. Redox active iron could trigger additional LP. Skin barrier function is intimately associated with lipid metabolism. Intensive LP, besides damaging cell membranes may affect skin barrier lipids [9] that might lead to further damage of the skin barrier function. Glutathione has been postulated to play an important role in inhibiting contact dermatitis [4]. Increase of GSSG/GSH before treatment and decrease after it confirms direct connection beJournal of Dermatological Science (2003) 33, 127 /129

Psoriasis and Cardiovascular Risk—Do Promising New Biomarkers Have Clinical Impact?

Epidemiological studies suggest an increased prevalence of cardiovascular disease (CVD) in patients with psoriasis (PS). Therefore, emphasis has lately been laid on the necessity for clinical evaluation of the risk of CVD in these patients. The systemic inflammatory markers C-reactive protein (CRP) and interleukin- (IL-) 6, which have long been used to predict future CVD in the general population, are increased manyfold in patients with PS. Lipid abnormalities characterized by elevated triglycerides, low HDL cholesterol, and higher concentrations of LDL cholesterol and its oxidized form are also prevalent in patients. There is a need for additional laboratory markers for the assessment of cardiovascular status of patients with PS. Due to frequent comorbid overweight and obesity, biologically active compounds produced by adipocytes may have an impact on monitoring the status of the cardiovascular system of patients with PS. For this purpose, two adipokines, adiponectin and leptin, have been most extensively studied. The review focuses on some inflammatory and oxidative stress aspects in patients with PS through the analysis of the impact of prominent adipokines and oxidized low-density lipoprotein (oxLDL) to assess their eligibility for clinical practice as markers of CVD risk in patients with PS.

Contact allergy to the ingredients of moisturizers in a boy with atopic dermatitis: CONTACT ALLERGY IN ATOPIC DERMATITIS

A 10-year-old boy was referred to our clinic for patch testing because of widespread dermatitis resistant to treatment, which had worsened during the summer. He had a history of AD from the age of 6 months, and of non-allergic asthma, diagnosed at the age of 1.5 years. Prick tests with indoor allergens, food allergens and pollens had repeatedly given negative results. The patient presented with papular rashes on the face, neck, axillary folds, and distal parts of the extremities. On the hands, there were also vesicles and crusts (Fig. 1). The child was patch tested, according to international recommendations (3), with the European baseline series

Multifocal Kaposi's sarcoma mimicking allergic vasculitis.

Sir, Kaposi’s sarcoma (KS) is a multifocal neoplastic process occurring predominantly in the dermal vasculature (1, 2). Bluish-red macules, plaques and tumours characterize the neoplasm, which most commonly affects the feet (1 – 3). The recognized clinical variants of KS include classic KS, endemic African KS, KS in iatrogenically immunocompromised patients and HIVassociated KS (1, 4). The discovery of herpes-virus-like DNA in all variants of KS supports a theory of viral aetiology for this neoplasm (3, 5, 6). The clinical course of KS in iatrogenically immunocompromised patients is similar to that of the classic KS, e.g. it is characterized by slow progression and predominantly benign course, but may be more aggressive in the case of continued immunosuppression (3). We report the case of a woman with corticosteroidtreated rheumatoid arthritis who presented with bilateral palpable purpura-like eruption on the dorsal feet initially diagnosed as hypersensitivity vasculitis. Her skin biopsy made 2 years later demonstrated typical histological signs of KS.