Caries-preventing effect of a hydroxyapatite-toothpaste in adults: a 18-month double-blinded randomized clinical trial

BackgroundDental caries is a worldwide challenge for public health. The aim of this 18-month double-blinded, randomized, clinical trial was to compare the caries-preventing effect of a fluoride-free, hydroxyapatite toothpaste (test) and a toothpaste with sodium fluoride (1450 ppm fluoride; positive control) in adults.MethodsThe primary endpoint was the percentage of subjects showing no increase in overall Decayed Missing Filled Surfaces (DMFS) index. The study was designed as non-inferiority trial. Non-inferiority was claimed if the upper limit of the exact one-sided 95% confidence interval for the difference of the primary endpoint DMFS between test and control toothpaste was less than the predefined margin of non-inferiority (Δ ≤ 20%).ResultsIn total, 189 adults were included in the intention-to-treat (ITT) analysis; 171 subjects finished the study per protocol (PP). According to the PP analysis, no increase in DMFS index was observed in 89.3% of subjects of the hydroxyapatite group and 87.4% of the subjects of the fluoride group. The hydroxyapatite toothpaste was not statistically inferior to a fluoride toothpaste with regard to the primary endpoint.ConclusionHydroxyapatite was proven to be a safe and efficient anticaries agent in oral care.Clinical trial registrationNCT04756557

Proprotein Convertase Subtilisin/Kexin Type 9, Angiopoietin-Like Protein 8, Sortilin, and Cholesteryl Ester Transfer Protein—Friends of Foes for Psoriatic Patients at the Risk of Developing Cardiometabolic Syndrome?

Psoriasis is a systemic, immune-metabolic disease with strong genetic predispositions and autoimmune pathogenic traits. During psoriasis progression, a wide spectrum of comorbidities comes into play with the leading role of the cardio-metabolic syndrome (CMS) that occurs with the frequency of 30–50% amongst the psoriatic patients. Both conditions—psoriasis and CMS—have numerous common pathways, mainly related to proinflammatory pathways and cytokine profiles. Surprisingly, despite the years of research, the exact pathways linking the occurrence of CMS in the psoriasis population are still not fully understood. Recently published papers, both clinical and based on the basic science, shed new light into this relationship providing an insight into novel key-players proteins with plausible effects on above-mentioned interplay. Taking into account recent advances in this important medical matter, this review aims to discuss comprehensively the role of four proteins: proprotein convertase subtilisin/kexin type-9 (PSCK9), angiopoietin-like protein 8 (ANGPLT8), sortilin (SORT1), and cholesteryl ester transfer proteins (CEPT) as plausible links between psoriasis and CMS

Cutaneous manifestations of autoimmune polyglandular syndrome type 1 – case report and literature review

Introduction. Autoimmune polyglandular syndrome type 1 (APS-1) is a type of polyendocrinopathy, inherited in an autosomal recessive manner. Beside the classic triad of symptoms (candidiasis of the skin and mucous membranes, hypoparathyroidism and Addison’s disease), other skin and systemic diseases may be present. Objective . To present a patient with history of APS-1, in whom in addition to the classic triad of symptoms vitiligo, alopecia, and dental enamel hypoplasia and nail dystrophy were observed. Case report . A 43-year-old patient, with a history of APS-1 syndrome, was admitted to the hospital because of exacerbation of candidiasis of the mucous membranes of the mouth. Additionally, dystrophy of the nails and the dental enamel, generalized alopecia and extensive vitiligo were observed. Due to antifungal treatment partial clinical improvement was achieved. Conclusions . APS-1 is a potentially life-threatening complex set of symptoms. Consistent treatment and strict follow-up of patients with this syndrome are necessary

Methotrexate Decreases the Level of PCSK9—A Novel Indicator of the Risk of Proatherogenic Lipid Profile in Psoriasis. The Preliminary Data

Background: Proprotein convertase subtilisin/kexin type 9 (PCSK9) exerts an important role in inflammatory processes, lipids homeostasis, and cardiometabolic disorders that are closely associated with psoriasis. The aim of the study was to analyze the clinical and diagnostic value of serum PCSK9 concentrations and their connections with disease severity, inflammation, metabolic syndrome, and impact of systemic therapies in psoriatic patients. The study enrolled thirty-five patients with active plaque-type psoriasis and eighteen healthy volunteers served as controls. Blood samples were obtained before and after 12 weeks of treatment with methotrexate or acitretin. Serum PCSK9 concentrations were measured by the ELISA (Enzyme-Linked Immunosorbent Assay) commercial kits. Morphological and biochemical parameters were assayed using routine laboratory techniques. Psoriatic patients showed significantly elevated levels of PCSK9 compared to controls (p < 0.01), mostly in patients with a mild and moderate course of psoriasis. PCSK9 concentrations correlated positively with BMI and triglyceride levels (p < 0.05). Interestingly, PCSK9 had a strong negative correlation with low-density lipoprotein levels and total cholesterol (p < 0.05). Three months of monotherapy with methotrexate significantly reduced PCSK9 level (p < 0.05), on the contrary, the acitretin group showed a further increase of PCSK9 levels (p < 0.05). PCSK9 seems to be a novel marker of psoriasis and a putative explanation of lipid disturbances, which are common in patients with psoriasis and are vital for the further developing of metabolic syndrome. Methotrexate should be considered as a treatment of choice in patients with an elevated PCSK9 concentration

Podobne czy różne? Opis przypadku problematycznego współwystępowania grzybicy z łuszczycą

Łuszczyca jest jedną z najczęstszych dermatoz na świecie. Jest to przewlekła choroba zapalna o podłożu immunologicznym, związana z wielogenową predyspozycją, stymulowana przez czynniki środowiskowe. Najbardziej charakterystycznymi zmianami skórnymi są dobrze odgraniczone blaszki łuszczycowe barwy czerwono-brunatnej, pokryte białosrebrzystymi łuskami. Łuszczyca może być mylona z innymi chorobami skóry, zwłaszcza zmianami wypryskowymi czy infekcjami grzybiczymi. Możliwe jest też ich współwystępowanie. Przedstawiamy przypadek 23-letniego pacjenta z wywiadem nawracających zmian skórnych z towarzyszącym łagodnym świądem. Pierwsze zmiany rozpoznano jako alergiczne zapalenie skóry, które kilkukrotnie z powodzeniem leczono miejscowymi glikokortykosteroidami. Trzy lata po pierwszym epizodzie nastąpiło zaostrzenie zmian skórnych opornych na wcześniejsze leczenie. Przeprowadzone bezpośrednie badanie mikologiczne okazało się pozytywne. Hodowle grzybów wykazały Trichophyton verrucosum i Candida spp. Pacjenta leczono systemowo terbinafiną oraz miejscowo cyklopiroksolaminą. Pomimo uzyskania znaczącej poprawy klinicznej nadal widoczna była częściowa aktywność z grudkami w obrębie ustępujących zmian skórnych. Wykonana biopsja skóry wykluczyła infekcję grzybiczą i wskazała na łuszczycę. Po zastosowanym leczeniu przeciwłuszczycowym uzyskano remisję

Similar or different? A case report of confusing coexistence of tinea and psoriasis

Psoriasis is one of the most common dermatoses worldwide. It is a chronic, immunologically mediated, inflammatory disease associated with the polygenic predisposition and stimulated by environmental factors. The most characteristic skin lesions include well-demarcated, erythematous plaques with silvery-white scales. Psoriasis is often misdiagnosed with other skin conditions, particularly dermatitis and fungal infections. Their coexistence is also possible. We present a case of a 23-year-old patient with a history of recurrent skin lesions with accompanying mild pruritus. The first lesions were diagnosed as allergic dermatitis and successfully treated with topical steroids several times. Three years after the first episode, the exacerbation of skin lesions resistant to previous treatment occurred. The direct mycological examination was positive. Fungal cultures indicated Trichophyton verrucosum and Candida spp. The patient was treated systemically with terbinafine and topical ciclopirox olamine. Although clinical improvement was achieved after a few weeks, still partial activity with papules within the residual lesions remained. The performed skin biopsy ruled out fungal infection and pointed to psoriasis. The antipsoriatic treatment resulted in remission

Enhanced Inflammation and Nitrosative Stress in the Saliva and Plasma of Patients with Plaque Psoriasis

Psoriasis is the most common inflammatory skin disease, characterized by the release of proinflammatory cytokines from lymphocytes, keratinocytes, and dendritic cells. Although psoriasis is considered an immune-mediated inflammatory disease, its effect on secretory activity of salivary glands and quantitative composition of saliva is still unknown. The aim of this study was to evaluate the secretion of saliva as well as several selected inflammation and nitrosative stress biomarkers in unstimulated and stimulated saliva as well as plasma of psoriasis patients. We demonstrated that, with progressing severity and duration of the disease, the secretory function of the parotid and submandibular salivary glands is lost, which is manifested as decreased unstimulated and stimulated saliva secretion and reduced salivary amylase activity and total protein concentration. The levels of tumor necrosis factor-alpha (TNF-α), interleukin-2 (IL-2), and interferon-gamma (INF-γ) were significantly higher, whereas interleukin-10 (IL-10) content was considerably lower in unstimulated and stimulated saliva of patients with psoriasis compared to the controls, and the changes increased with the disease duration. Similarly, we observed that the intensity of nitrosative stress in the salivary glands of psoriasis patients depended on the duration of the disease. By means of receiver operating characteristic (ROC) analysis, we showed that the evaluation of nitric oxide (NO), nitrotyrosine, and IL-2 concentration in non-stimulated saliva with high sensitivity and specificity differentiated psoriasis patients on the basis of the rate of saliva secretion (normal salivation vs. hyposalivation). In summary, the dysfunction of salivary glands in psoriasis patients is caused by inflammation and nitrosative stress

Salivary Antioxidants and Oxidative Stress in Psoriatic Patients: Can Salivary Total Oxidant Status and Oxidative Status Index Be a Plaque Psoriasis Biomarker?

The aim of our research was to evaluate redox balance parameters and biomarkers of oxidative stress (OS) in nonstimulated and stimulated saliva as well as the blood of patients with plaque psoriasis compared to healthy controls. The study involved 40 patients with plaque psoriasis and 40 generally healthy subjects matched by age and gender to the study group patients. We assayed the concentration/activity of antioxidant enzymes: salivary peroxidase (Px), catalase (CAT), and superoxide dismutase (SOD) measured in unstimulated saliva (NWS), stimulated saliva (SWS), and erythrocytes. In plasma as well as NWS and SWS, we measured the concentration/activity of reduced glutathione (GSH), total antioxidant potential (TAC), total oxidative status (TOS), oxidative stress index (OSI), and markers of oxidative modification of proteins: advanced glycation end products (AGE), advanced oxidation protein products (AOPP), and lipid oxidation products: malondialdehyde (MDA) and total lipid hydroperoxide (LOOH). In NWS and SWS, we also evaluated the rate of reactive oxygen species (ROS) production. The concentration of Px, CAT, and SOD was significantly higher in NWS of patients with plaque psoriasis vs. healthy subjects. In SWS of psoriatic patients, we observed considerably higher concentration of Px and CAT, and in erythrocytes of patients with plaque psoriasis, the concentration of GPx and CAT was significantly higher compared to that in the controls. The levels of AOPP, AGE, MDA, and LOOH were considerably higher in NWS, SWS, and plasma of the study group compared to the controls. The concentration of total protein and salivary amylase was significantly lower in NWS and SWS of psoriatic patients compared to the healthy control. In the course of plaque psoriasis, we observed redox imbalances with prevalence of oxidation reactions. Mechanisms involved in the synthesis/secretion of proteins and activity of amylase were depressed in both glands of psoriatic patients; however, they were more inhibited in the parotid gland compared to the submandibular gland. TOS concentration and OSI value in NWS and SWS may serve as diagnostic biomarkers of plaque psoriasis

Serum Cholesteryl Ester Transfer Protein (CETP) and Sortilin (SORT) in Patients with Psoriasis with Relation to Systemic Treatment

Psoriasis is a common inflammatory skin disease, which is tightly associated with metabolic disorders. Cholesteryl ester transfer protein (CETP) and sortilin (SORT) are molecules engaged in lipid metabolism of proatherogenic properties. They have been hardly ever studied in psoriasis before. Serum CETP and SORT concentrations were measured in 33 patients with plaque-type psoriasis before and after 12 weeks of treatment with methotrexate or acitretin. There was no significant difference in CEPT and SORT serum concentrations between patients and controls. Positive correlations between CETP after the treatment with acitretin and activity of transaminases (R = 0.65, R = 0.56, respectively) were noted. CETP was positively related with triglycerides (R = 0.49), glucose (R = 0.54) and CRP (R = 0.64) before the treatment with methotrexate, which all disappeared afterwards. Systemic therapy with methotrexate caused normalization of SORT concentration. There was significant correlation between SORT and WBC (p < 0.01) and CRP (p < 0.05). CETP and SORT cannot be used as individual biomarkers. Nevertheless, they show some interesting relations with other parameters. Increased concentration of CETP perhaps could investigated as a marker of liver side effects of acitretin treatment in psoriatics. SORT could be considered as a new indicator of metabolically induced inflammation in psoriasis. Methotrexate may be preferred in patients with high SORT concentrations. Further studies are needed to establish their exact role in psoriatic patients