Yozo Ishiuji

Impact of disease severity on work productivity and activity impairment in Japanese patients with atopic dermatitis.

Atopic dermatitis (AD) is a common inflammatory skin disease that is characterized by chronic and persisting pruritic and eczematous lesions. There has been no study of work productivity and activity in AD patients in relation to disease severity. The purpose of this study was to examine the impact of disease severity on work productivity and activity impairment (WPAI) in adult AD patients using the Japanese version of the questionnaire. Data were collected from 112 AD patients who visited the Jikei University Hospital. Outcomes as measured by the questionnaire included employment status, total work productivity impairment (TWPI) and total activity impairment (TAI). We investigated the correlation between TWPI or TAI scores and severity scoring of AD (SCORAD) for disease severity and dermatology life quality index (DLQI) for quality of life impairment. Both TWPI and TAI scores were significantly correlated with the SCORAD and DLQI scores (P < 0.001), indicating disease severity is significantly associated with WPAI in Japanese adult AD patients. Further studies are necessary to evaluate the effects of treatments on WPAI for severe AD patients.

IL-10-producing regulatory B cells are decreased in patients with psoriasis

BACKGROUNDS Interleukin (IL)-10-producing regulatory B cells (B10 cells) have been shown to ameliorate psoriasis in mice. Human B10 progenitor cells are characterized as CD19(+)CD24(hi)CD38(hi) B cells that exert their regulatory functions via the production of IL-10. However, the role of B10 cells in the pathogenesis of psoriasis remains unclear. OBJECTIVES We examined B10 cells in patients with psoriasis and healthy controls. METHODS Peripheral blood mononuclear cells were isolated from psoriasis patients without a history of receiving any immunosuppressants during the 6-month period before enrollment in the study. Using flow cytometry, we determined the frequencies of blood B cell subsets, B10 progenitor cells, and B10 cells for 31 patients with psoriasis and 26 healthy controls. RESULTS Both psoriasis patients and healthy controls showed similar frequencies of total B cells, IgD(+)CD27(-) naïve B cells, and IgD(-)CD27(+) memory B cells. However, the frequency of CD19(+)CD24(hi)CD38(hi) B10 progenitor cells was significantly higher in patients with psoriasis than in the healthy controls. In contrast, the frequency of B10 cells in patients with psoriasis was significantly lower than that in healthy controls. Furthermore, treatment with immunosuppressants resulted in a decrease in B10 progenitor cells and an increase in B10 cells. CONCLUSION B10 progenitor cells were increased, while IL-10-producing regulatory B10 cells were decreased in patients with psoriasis, suggesting that B10 cells may be functionally impaired in patients with psoriasis.

Genetic polymorphism in the TRAF3IP2 gene is associated with psoriasis vulgaris in a Japanese population.

[2] Sano S, Chan KS, Carbajal S, Clifford J, Peavey M, Kiguchi K, et al. Stat3 links activated keratinocytes and immunocytes required for development of psoriasis in a novel transgenic mouse model. Nat Med 2005;11:43–9. [3] Nakajima K, Kanda T, Takaishi M, Shiga T, Miyoshi K, Nakajima H, et al. Distinct roles of IL-23 and IL-17 in the development of psoriasis-like lesions in a mouse model. J Immunol 2011;186:4481–9. [4] Kunz S, Wolk K, Witte E, Witte K, Doecke WD, Volk HD, et al. Interleukin (IL)19, IL-20 and IL-24 are produced by and act on keratinocytes and are distinct from classical ILs. Exp Dermatol 2006;15:991–1004. [5] He M, Liang P. IL-24 transgenic mice: in vivo evidence of overlapping functions for IL-20, IL-22, and IL-24 in the epidermis. J Immunol 2010;184: 1793–8. [6] Chan JR, Blumenschein W, Murphy E, Diveu C, Wiekowski M, Abbondanzo S, et al. IL-23 stimulates epidermal hyperplasia via TNF and IL-20R2-dependent [10] Cai Y, Shen X, Ding C, Qi C, Li K, Li X, et al. Pivotal role of dermal IL-17-producing gammadelta T cells in skin inflammation. Immunity 2011;35:596–610.

Usefulness of dual-energy computed tomography for the evaluation of early-stage psoriatic arthritis only accompanied by nail psoriasis

Dear Editor, A 26-year-old man presented with a 2-year history of tender swelling of the distal phalanx toward the interphalangeal joint of the right thumb, and also around the distal interphalangeal (DIP) joints of the left middle and little fingers. Nine out of 10 fingernails showed deformities, and they were notable on the corresponding tender fingers (Fig. 1a). Some toenails also showed thickening, but without tenderness. Serum C-reactive protein level and rheumatoid factor were negative. There were no other cutaneous lesions, including the hands. Dermoscopy of the hyponychium showed no apparent capillary patterns, and X ray of the hands showed no abnormalities (Fig. 1b). A dual-energy computed tomography (DE-CT) iodine map of the left hand (Fig. 1c) revealed prominent enhancement from the attachment site of the extensor tendon to the thickened nail bed. Axial and coronal images showed swelling and abnormal enhancement in the nail root, while the joint capsular synovium of the DIP joint was relatively spared. Those abnormal enhancements were considered as active enthesitis, leading to the diagnosis of early-stage psoriatic arthritis (PsA). Adalimumab was initiated at 80 mg at baseline, and thereafter 40 mg every 2 weeks without topical agents for the treatment of nail psoriasis. Finger joint tenderness disappeared immediately with gradual improvement of nail deformities (Fig. 1d). Four months later, DE-CT showed remarkable improvement of abnormal enhancements and nail bed thickness (Fig. 1e). The notable feature of our patient was the absence of cutaneous eruptions. We confirmed the diagnosis of early-stage PsA in association with nail changes by demonstrating characteristic enthesitis accompanying abnormal nail bed enhancement by DE-CT, and therefore further nail biopsy was not considered necessary. According to the Classification Criteria for Psoriatic Arthritis, the presence of nail psoriasis is one of the key elements for the diagnosis of PsA. DE-CT imaging strongly supports the notion that nail changes represent inflammation over the nail bed and matrix extending from enthesitis, due to an association that exists between these structures and the nearby tendons and ligaments. Consequently, nail

Retiform hemangioendothelioma treated with conservative therapy: report of a case and review of the literature.

Retiform hemangioendothelioma (RH) is a locally aggressive vascular tumor. Wide surgical excision with tumor‐free margins is the standard treatment strategy. However, surgical excision is not an option for lesions near critical anatomical structures, such as those on the face. We report the case of a patient with retiform hemangioendothelioma that responded to non‐surgical treatments.

Pruritus in Autoimmune Diseases

Autoimmune diseases are a collection of more than 80 individual diseases that are estimated to affect more than 3% of the U.S. population.1 Underlying this diverse group of diseases is one common pathology: the malfunction of the immune system, resulting in the destruction of self-tissue. The etiology of autoimmune diseases is thought to have both genetic and environmental contributions.

Exacerbation of atopic dermatitis symptoms by ustekinumab in psoriatic patients with elevated serum immunoglobulin E levels: Report of two cases

Psoriasis is a chronic inflammatory skin disease mainly mediated by a T‐helper cell subset, Th17 cells. Recently, increased levels of total serum immunoglobulin (Ig)E have been reported in a subset of psoriatic patients. Ustekinumab (UST) is one of the most commonly used biologic agents for the treatment of moderate to severe plaque psoriasis, and a previous report also documented effectiveness of UST for psoriatic patients with high serum IgE levels. We experienced two psoriatic patients with high serum IgE levels, in whom UST completely improved psoriasis but paradoxically provoked or exacerbated atopic dermatitis (AD)‐like symptoms. This reciprocal phenomenon suggests the shift of Th balance toward Th2, along with altered profiles of inflammatory cytokines. It appears prudent to consider the possibility of such adverse effects when treating psoriatic patients with UST with concomitant AD symptoms, a history of AD or high serum IgE levels.

Recurrent neutrophilic dermatosis of the face: A report of two cases and review of the published work.

Recurrent neutrophilic dermatosis of the face is a disease that is morphologically and histopathologically compatible with Sweets syndrome, but is distributed on the face without fever, laboratory abnormalities or associated disorders. At present, it is unclear whether our cases belong to the chronic and mild variant of Sweets syndrome or are independent entities. Here, we present two cases of recurrent neutrophilic dermatosis of the face with good response to systemic corticosteroids or potassium iodine, as well as those of cases reported in the published work.