Interstitial Granulomatous Dermatitis: Another Clinical Variant

A 70-year-old female patient presented with an eruption consisting of symmetrically distributed erythematous papules around the umbilicus 1 month after the cessation of adalimumab for the treatment of rheumatoid arthritis. Biopsy of a papule showed an interstitial granulomatous infiltrate in the dermis, without deposition of mucin. The lesions cleared only after re-initiation of treatment 2 months later. Interstitial granulomatous dermatitis is thought to be a distinct histopathological pattern, either drug induced or associated with rheumatoid arthritis or autoimmune collagen diseases. In our case, there was a distinct clinical presentation of interstitial granulomatous dermatitis, composed of symmetrically distributed indurated papules around the umbilicus as well as a mild granulomatous reaction pattern

Detection of IgG autoantibodies against desmocollin–3 in Greek patients with pemphigus

Pemphigus is an autoimmune bullous disorder caused by autoantibodies against desmosomal cadherins. The most common clinical forms are pemphigus vulgaris (PV) and pemphigus foliaceus (PF). Among the numerous proteins that are considered responsible for the cohesion of keratinocytes in epidermis, desmocollin-3 (Dsc-3) has been initially reported to participate in epidermal blistering in mice. There have been reports in which autoantibodies against Dsc-3 have been detected. In PV, a limited number of studies found no presence of IgG or IgA autoantibodies against Dsc-3. In this study we examined sera from Greek patients with PV and PF for the presence of IgG autoantibodies against Dsc-3. Immunoblotting for the detection of autoantibodies against Dsc-3 was performed in sera from all cases. Dsc-3 autoantibodies were not detected in either group (PV and PF). Our results confirm the hypothesis that the pathogenic role of Dsc-3 in epidermal blistering in PV and PF remains controversial. </p

Fungal Infections and Nail Psoriasis: An Update

The relationship between psoriasis and onychomycosis is controversial, and the exact nature of this association remains to be clearly elucidated. In healthy nails, the compact nail plate acts as a barrier, preventing any infection. In psoriatic nails, the nail plate involvement, together with abnormalities in the blood capillaries, may lead to decreased natural defenses against microorganisms. Moreover, onycholysis (detachment of the nail plate) induces a humid environment that may favor fungal proliferation. Treatment with immunosuppressive drugs may additionally enhance onychomycosis. In this comprehensive review, we present data regarding the incidence and pathogenic action of dermatophytes and other fungi in the development of fungal infection in psoriatic nails

Detailed study of psoriatic nail features and detection of possible correlation between nail psoriasis severity index (NAPSI) and indicators of inflammation

Psoriasis affects the skin, joints and nails. Nail psoriasis is associated with higher disease severity and quality of life impairment. TNF-α, IL-12/23 p40, and IL-17 play an important role in the pathogenesis of psoriasis. Our initial aim was to study the presence of nail involvement in patients with psoriasis, its characteristics and its possible correlations. Psoriatic patients, who suffered from any type of skin psoriasis and had not received any systematic antipsoriatic treatment or any topical treatment against nail psoriasis for at least a year, were recruited. Nail psoriasis was present in 67% of patients. The most common nail psoriasis feature was oil drop, followed by onycholysis and pitting. None of the covariates (age, gender, age at onset of psoriasis, skin psoriasis duration, psoriasis type, joint involvement and family history of psoriasis) were significant in predicting nail psoriasis indicating that nail psoriasis may evolve independently. Moreover, we aimed to evaluate the relationship between PASI and NAPSI and their correlations with DLQI and NPQ10, as well as to search for the agreement among the different ways of measuring NAPSI. Of the initially recruited patients, those, who were adults, suffered from chronic plaque psoriasis and provided their informed consent to fill in the questionnaires and undergo vein puncture, were selected. PASI was significantly correlated with DLQI. In patients with nail involvement, there was a significant correlation between PASI and NAPSI. Moreover, NPQ10 was significantly correlated with both NAPSI and DLQI. Significant correlations were established, indicating good agreement among the different ways of measuring NAPSI. Taking into consideration the above mentioned results and the fact that a target nail assessment is quicker to be performed than a 20 nail assessment, as well as that the 8-point scale is easier to carry out compared to the 32-point one, maybe the 8-point target nail NAPSI could be proposed to be used in clinical trials and practice. Last, we aimed to compare the serum levels of TNF-α, IL-12/23 p40, and IL-17 in psoriatic patients with and without nail involvement, as well as to evaluate the correlations of the serum levels of TNF-α, IL-12/23 p40, and IL-17 with the target NAPSI score. Of the above-mentioned patients, with plaque psoriasis, were further excluded those with PASI ≥ 12 and/or psoriatic arthritis. The serum levels of TNF-α were significantly higher in the group of psoriatic patients presenting both cutaneous and nail lesions compared to those with only cutaneous lesions. However, the serum levels of either IL-12/23p40 or IL-17 did not significantly differ between the 2 groups. The target NAPSI score presented high, positive statistically significant correlation with the serum levels of TNF-α. On the contrary, target NAPSI score was not significantly correlated with either the serum levels of IL-12/23 p40 or the serum levels of IL-17. These results confirm the important role of TNF-α in the pathogenesis of nail psoriasis and may suggest that anti-TNF agents could be more beneficial on psoriatic nail disease than agents targeting IL-12/23 p40 or IL-17 and its receptors.Η ψωρίαση μπορεί να προσβάλλει το δέρμα, τις αρθρώσεις και τα νύχια. Η ψωριασική ονυχία σχετίζεται με βαρύτερη μορφή ψωρίασης και με σημαντικά χαμηλότερη ποιότητα ζωής. Οι παράγοντες TNF-α, IL-12/23 p40 και IL-17 παίζουν σημαντικό ρόλο στην παθογένεια της ψωρίασης. Για το λόγο αυτό, πολλές νέες θεραπείες στοχεύουν σε αυτούς ή σε υποδοχείς τους. Αρχικός στόχος ήταν η μελέτη των αλλοιώσεων της ψωριασικής ονυχίας και συσχέτισή τους με δημογραφικές και κλινικές παραμέτρους. Για το σκοπό αυτό επιλέχθηκαν άτομα που έπασχαν από οποιαδήποτε μορφή ψωρίασης, και δεν είχαν λάβει συστηματική αντιψωριασική ή ορισμένη τοπική θεραπεία έναντι της ψωριασικής τους ονυχίας για τουλάχιστον ένα έτος. Το 67% των ασθενών παρουσίαζε ψωριασική ονυχία. Η συχνότερα παρατηρούμενη αλλοίωση ήταν η σταγόνα ελαίου, ενώ ακολούθησαν η ονυχόλυση και τα βοθρία. Καμία από τις συμμεταβλητές (ηλικία, φύλο, ηλικία εμφάνισης της ψωρίασης, διάρκεια της ψωρίασης, ύπαρξη οικογενειακού ιστορικού και συμμετοχή των αρθρώσεων) δεν ήταν σημαντικές στην πρόβλεψη της ψωριασικής ονυχίας. Έπειτα μελετήθηκε η συσχέτιση της ποιότητας ζωής και βαρύτητας της ψωρίασης του δέρματος και των ονύχων σε ψωριασικούς ασθενείς και εκτιμήθηκε η συμφωνία μεταξύ των διαφορετικών τρόπων μέτρησης της ειδικής κλίμακας βαρύτητας NAPSΙ. Από τους αρχικούς ασθενείς επιλέχθηκαν οι ενήλικες ασθενείς που έπασχαν από κοινή κατά πλάκας ψωρίαση και έδωσαν τη συγκατάθεσή τους για να συμπληρώσουν τα ερωτηματολόγια και να υποβληθούν σε αιμοληψία. Στους ασθενείς με συνοδό ψωριασική ονυχία, υπήρχε μια σημαντική σχέση μεταξύ του PASI και του NAPSI. Επιπρόσθετα, το NPQ10 συσχετίζονταν σημαντικά τόσο με το NAPSI όσο και με το DLQI. Σημαντικές συσχετίσεις βρέθηκαν μεταξύ των διάφορων τρόπων μέτρησης του NAPSI σε ασθενείς που πάσχουν από κοινή, γενικευμένη κατά πλάκας ψωρίαση με συνοδό ονυχία, υποδεικνύοντας την ύπαρξη συμφωνίας μεταξύ των διαφορετικών τρόπων μέτρησής του. Λαμβάνοντας υπόψη τα παραπάνω, καθώς και ότι το NAPSI του «όνυχα-στόχου» (0-8) είναι απλούστερο και γρηγορότερο στην εφαρμογή του σε σχέση με τους λοιπούς τρόπους, καλό θα ήταν να προταθεί η χρήση του στην καθημερινή κλινική πράξη. Τέλος, έγινε μελέτη των επιπέδων των TNF-α, IL-12/23 p40 και IL-17 στον ορό ψωριασικών ασθενών που εμφανίζουν ή όχι ονυχία, και διερευνήθηκε η συσχέτιση των επιπέδων των παραπάνω κυτταροκινών με το NAPSI. Από τους ενήλικες ασθενείς που έπασχαν από κοινή κατά πλάκας ψωρίαση και έδωσαν τη συγκατάθεσή τους, επιλέχθηκαν όσοι είχαν PASI<12 και/ή δεν εμφάνιζαν ψωριασική αρθρίτιδα. Τα επίπεδα του TNF-α ήταν σημαντικά υψηλότερα στην ομάδα των ψωριασικών ασθενών με συνοδό ονυχία σε σύγκριση με αυτούς που εμφάνιζαν βλάβες μόνο στο δέρμα. Εντούτοις, τα επίπεδα της IL-12/23 p40 και IL-17 στον ορό των ψωριασικών ασθενών δε διέφεραν σημαντικά στις 2 ομάδες. Το NAPSI του «όνυχα-στόχου» παρουσίασε συσχέτιση με τα επίπεδα του TNF-α στον όρο των ψωριασικών ασθενών με συνοδό ψωριασική ονυχία. Αντιθέτως, το NAPSI του «όνυχα-στόχου» δε συσχετίζονταν με τα επίπεδα της IL-12/23 p40 και IL-17. Τα αποτελέσματα επιβεβαιώνουν το σημαντικό ρόλο του TNF-α στην παθογένεια της ψωριασικής ονυχίας και ίσως υποδηλώνουν ότι οι θεραπευτικοί παράγοντες έναντί του θα μπορούσαν να είναι περισσότερο ευεργετικοί στην αντιμετώπιση της ψωριασικής ονυχίας σε σχέση με τους παράγοντες έναντι των IL-12/23 p40, IL-17 και των υποδοχέων τους

Association of Autoantibodies to BP180 with Disease Activity in Greek Patients with Bullous Pemphigoid

39 bullous pemphigoid (BP) patients were studied to assess the clinical significance of anti-BP180 and anti-BP230 circulating autoantibodies of BP and correlate their titers with the clinical scores of the BP Disease Area Index (BPDAI) and the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) as well as with the intensity of pruritus measured by the BPDAI pruritus component. All parameters were evaluated by the time of diagnosis (baseline), month 3, and month 6. Titers of anti-BP180 autoantibodies were strongly correlated with BPDAI (, ) and ABSIS (, ) values, as well as with BPDAI component for the intensity of pruritus (, ) at baseline. At month 3, titers of anti-BP180 autoantibodies were strongly correlated with BPDAI (, ) and ABSIS (, ) values, as well as with the BPDAI component for the intensity of pruritus (, ). At month 6, titers of anti-BP180 autoantibodies were strongly correlated with BPDAI (, ) and ABSIS (, ) values, as well as with the BPDAI component for the intensity of pruritus (, ). There was no statistically significant correlation between titers of anti-BP230 autoantibodies and the BPDAI, ABSIS, and BPDAI component for the intensity of pruritus at the same time points

Serum Levels of TNF-α, IL-12/23p40, and IL-17 in Plaque Psoriasis and Their Correlation with Disease Severity

A case-control study was performed to assess the serum levels of TNF-α, IL-12/23p40, and IL-17 in patients with plaque psoriasis, compare them with healthy controls, and correlate them with disease severity, as represented by Psoriasis Area Severity Index (PASI). 32 consecutively selected, untreated patients with active, chronic plaque psoriasis were recruited and compared to 32 age- and sex-matched healthy controls. Serum cytokine levels were determined by solid phase sandwich enzyme linked immunosorbent assay (R&D Systems Europe, Ltd.). The mean serum levels of TNF-α were significantly higher in psoriatic patients compared to those of controls (Mann-Whitney U test; P=0.000). However, the median serum levels of neither IL-12/23p40 nor IL-17 differ significantly between the 2 groups (Mann-Whitney U test; P=0.968 and P=0.311, resp.). No significant correlations were found between PASI and any of the cytokine serum levels (Spearman’s rank test; P>0.05). Despite the well-evidenced therapeutic efficacy of biologic agents targeting TNF-α, IL-12/23p40, and IL-17, serum levels of TNF-α, IL-12/23p40, and IL-17 do not seem to correlate with the severity of psoriatic skin disease in untreated patients, as represented by PASI. Further investigation may add more data on the pathogenetic cascade of psoriasis

Serum Levels of TNF-, IL-12/23 p40, and IL-17 in Psoriatic Patients with and without Nail Psoriasis: A Cross-Sectional Study

Nail involvement has started playing a major role in the overall assessment and management of psoriatic disease. Biologics indicated for moderate to severe chronic plaque psoriasis are shown to be beneficial in nail disease. This study aimed to assess and compare the serum levels of TNF-, IL-12/23 p40, and IL-17 in psoriatic patients with and without nail involvement. 52 consecutively selected patients with chronic plaque psoriasis were included in this cross-sectional study. Patients were studied and analyzed after they had been divided into 2 groups regarding the presence (n = 24) or not (n = 28) of nail psoriasis. The mean serum levels of TNF-were significantly higher in the group of psoriatic patients with nail lesions compared to those without (t-test; 5.40 ± 1.17 versus 3.80 ± 1.63, P = 0.026). However, the median serum levels of both IL-12/23 p40 , P = 0.297) and ), P = 0.714) did not significantly differ between the 2 groups. These results confirm the important role of TNF-in the pathogenesis of nail psoriasis and may suggest that anti-TNF agents could be more beneficial in psoriatic nail disease than agents targeting IL-12/23 p40 or IL-17 and its receptors

Serum Levels of TNF- α

Nail involvement has started playing a major role in the overall assessment and management of psoriatic disease. Biologics indicated for moderate to severe chronic plaque psoriasis are shown to be beneficial in nail disease. This study aimed to assess and compare the serum levels of TNF-α, IL-12/23 p40, and IL-17 in psoriatic patients with and without nail involvement. 52 consecutively selected patients with chronic plaque psoriasis were included in this cross-sectional study. Patients were studied and analyzed after they had been divided into 2 groups regarding the presence (n = 24) or not (n = 28) of nail psoriasis. The mean serum levels of TNF-α were significantly higher in the group of psoriatic patients with nail lesions compared to those without (t-test; 5.40 ± 1.17 versus 3.80 ± 1.63, P = 0.026). However, the median serum levels of both IL-12/23 p40 (Mann-Whitney; 92.52 (34.35–126.87) versus 150.68 (35.18–185.86), P = 0.297) and IL-17 (Mann-Whitney; 28.49 (0.00–28.49) versus 8.59 (0.00–8.59), P = 0.714) did not significantly differ between the 2 groups. These results confirm the important role of TNF-α in the pathogenesis of nail psoriasis and may suggest that anti-TNF agents could be more beneficial in psoriatic nail disease than agents targeting IL-12/23 p40 or IL-17 and its receptors

Piperacillin/Tazobactam as Cause of Acute Generalized Exanthematous Pustulosis

Acute generalized exanthematous pustulosis (AGEP) is a rare cutaneous adverse reaction mainly attributed to antibiotics. It is characterized by numerous, nonfollicular, sterile pustules, arising on an exanthematous and edematous base. It is a serious adverse reaction accompanied by fever and leukocytosis. Piperacillin/tazobactam is indicated for the treatment of patients with moderate to severe infections. Herein is reported a case of AGEP caused by piperacillin/tazobactam. A 78-year-old woman with metastatic breast cancer was presented to the emergency department reporting fever and groin pain. The laboratory analysis and more specifically urine cultivation showed a urinary tract infection by E. coli with sensitivity to piperacillin/tazobactam. She had no known allergies. She was started on intravenous piperacillin/tazobactam; she improved clinically on the second day, but on the fourth day of intravenous therapy, she developed extensive pustular rash on the folds and anterior proximal thighs, accompanied by fever and neutrophilia. Piperacillin/tazobactam administration was interrupted and she was given prednisolone for ten days. The patient improved clinically and her laboratory tests returned to normal after two weeks. AGEP is an uncommon side effect of piperacillin/tazobactam treatment and there are few cases reported