Isolated lip dermatitis (atopic cheilitis), successfully treated with topical tacrolimus 0.03%

Exfoliative and erosive cheilitis, may be a source of speech and chewing discomfort, but may also be an aesthetic issue for the patients affected. Such a clinical presentation may implicate a variety of inflammatory conditions, including atopic (eczematous) cheilitis. Topical and systemic agents, e.g. corticosteroids, have been used to treat inflammatory lip conditions. Topical tacrolimus has also been used in some inflammatory lip conditions. We performed a retrospective clinical analysis of atopic cheilitis patients. Between 2015 and 2020, we addressed 7 (seven) patients with atopic dermatitis affecting only lips and were diagnosed as atopic-eczematous cheilitis. They were treated with 0.03 per cent topical tacrolimus ointment and responded completely. These cases represent an underreported atopy / eczema event;-few cases of atopic cheilitis without concomitant dermal lesions appear in the literature. We are also showing and discussing yet another application of tacrolimus in a local atopic form of inflammation affecting the lips

Relationship Between Foveal Cone Structure and Visual Acuity Measured With Adaptive Optics Scanning Laser Ophthalmoscopy in Retinal Degeneration.

PurposeTo evaluate foveal function in patients with inherited retinal degenerations (IRD) by measuring visual acuity (VA) after correction of higher-order aberrations.MethodsAdaptive optics scanning laser ophthalmoscopy (AOSLO) was used to image cones in 4 healthy subjects and 15 patients with IRD. The 840-nm scanning laser delivered an "E" optotype to measure AOSLO-mediated VA (AOSLO-VA). Cone spacing was measured at the preferred retinal locus by two independent graders and the percentage of cones below the average density of 47 age-similar healthy subjects was computed. Cone spacing was correlated with best-corrected VA measured with the Early Treatment of Diabetic Retinopathy Study protocol (ETDRS-VA), AOSLO-VA, and foveal sensitivity.ResultsETDRS-VA significantly correlated with AOSLO-VA (ρ = 0.79, 95% confidence interval [CI] 0.5-0.9). Cone spacing correlated with AOSLO-VA (ρ = 0.54, 95% CI 0.02-0.7), and negatively correlated with ETDRS letters read (ρ = -0.64, 95% CI -0.8 to -0.2). AOSLO-VA remained ≥20/20 until cones decreased to 40.2% (CI 31.1-45.5) below normal. Similarly, ETDRS-VA remained ≥20/20 until cones were 42.0% (95% CI 36.5-46.1) below normal. Cone spacing z scores negatively correlated with foveal sensitivity (ρ = -0.79, 95% CI -0.9 to -0.4) and foveal sensitivity was ≥35 dB until cones were 43.1% (95% CI 39.3-46.6) below average.ConclusionsVA and foveal cone spacing were weakly correlated until cones were reduced by 40% to 43% below normal. The relationship suggests that VA is an insensitive measure of foveal cone survival; cone spacing may be a more sensitive measure of cone loss

Loss of Foveal Cone Structure Precedes Loss of Visual Acuity in Patients With Rod-Cone Degeneration.

PurposeTo assess the relationship between cone spacing and visual acuity in eyes with rod-cone degeneration (RCD) followed longitudinally.MethodsHigh-resolution images of the retina were obtained using adaptive optics scanning laser ophthalmoscopy from 13 eyes of nine RCD patients and 13 eyes of eight healthy subjects at two sessions separated by 10 or more months (mean 765 days, range 311-1935 days). Cone spacing Z-score measured as close as possible (average <0.25°) to the preferred retinal locus was compared with visual acuity (letters read on the Early Treatment of Diabetic Retinopathy Study [ETDRS] chart and logMAR) and foveal sensitivity.ResultsCone spacing was significantly correlated with ETDRS letters read (ρ = -0.47, 95%CI -0.67 to -0.24), logMAR (ρ = 0.46, 95%CI 0.24 to 0.66), and foveal sensitivity (ρ = -0.30, 95%CI -0.52 to -0.018). There was a small but significant increase in mean cone spacing Z-score during follow-up of +0.97 (95%CI 0.57 to 1.4) in RCD patients, but not in healthy eyes, and there was no significant change in any measure of visual acuity.ConclusionsCone spacing was correlated with visual acuity and foveal sensitivity. In RCD patients, cone spacing increased during follow-up, while visual acuity did not change significantly. Cone spacing Z-score may be a more sensitive measure of cone loss at the fovea than visual acuity in patients with RCD

A Smartphone-Based Tool for Rapid, Portable, and Automated Wide-Field Retinal Imaging.

Purpose:High-quality, wide-field retinal imaging is a valuable method for screening preventable, vision-threatening diseases of the retina. Smartphone-based retinal cameras hold promise for increasing access to retinal imaging, but variable image quality and restricted field of view can limit their utility. We developed and clinically tested a smartphone-based system that addresses these challenges with automation-assisted imaging. Methods:The system was designed to improve smartphone retinal imaging by combining automated fixation guidance, photomontage, and multicolored illumination with optimized optics, user-tested ergonomics, and touch-screen interface. System performance was evaluated from images of ophthalmic patients taken by nonophthalmic personnel. Two masked ophthalmologists evaluated images for abnormalities and disease severity. Results:The system automatically generated 100° retinal photomontages from five overlapping images in under 1 minute at full resolution (52.3 pixels per retinal degree) fully on-phone, revealing numerous retinal abnormalities. Feasibility of the system for diabetic retinopathy (DR) screening using the retinal photomontages was performed in 71 diabetics by masked graders. DR grade matched perfectly with dilated clinical examination in 55.1% of eyes and within 1 severity level for 85.2% of eyes. For referral-warranted DR, average sensitivity was 93.3% and specificity 56.8%. Conclusions:Automation-assisted imaging produced high-quality, wide-field retinal images that demonstrate the potential of smartphone-based retinal cameras to be used for retinal disease screening. Translational Relevance:Enhancement of smartphone-based retinal imaging through automation and software intelligence holds great promise for increasing the accessibility of retinal screening

Study of Langerhans cells in oral squamous cell carcinoma: immunohistochemical identification with S-100 protein

IN THE PRESENT STUDY AN EFFORT WAS MADE TO INVESTIGATE ORAL SQUAMUS CELL CARCINOMA FOR THE PRESENCE OF LANGERHANS CELLS (L.C) IN FORMALIN-FIXED, PARAFIN-EMBEDED MATERIAL, BY USING S-100 PROTEIN IN THE INDIRECT IMMUNOPEROXIDASE METHOD. ITWAS FOUND THAT: 1) S-100 PROTEIN IS A GOOD MARKER FOR THE IMMUNOHISTOCHEMICAL IDENTIFICATION OF L.C IN ORAL SQUAMUS CELL CARCINOMA, IN PARAFIN SECTIONS. 2) THE INDIRECT IMMUNOPEROXIDASE METHOD AS WE USED IT IN COMBINATION WITH TRYPSIN, GIVES SATISFACTORY RESULTS FOR THE DEFINITION OF S-100 POSITIVE L.C. 3) A GREATER NUMBER OF L.C IN THE NEOPLASTIC EPITHELIUM OF ORAL SQUAMUS CELL CARCINOMA INCOMPARISON WITH THAT OF THE CONNECTIVE TISSUE ADJACENT TO THE NEOPLASTIC EPITHELIUM AND IN THE NON- NEOPLASTIC EPITHELIUM IS A STATISTICALLY SIGNIFICANT DIFFERENCE. 4) THE NUMBER OF L.C IN THE CONNECTIVE TISSUE, ADJACENT TO THE NEOPLASTIC EPITHELIUM WAS GREATER THAN THAT OF THE LAMINA PROPRIA OF THE NON-NEOPLASTICEPITHELIUM IN A STATISTICALLY SIGNIFICANT DIFFERENCE AS WELL. 5) THERE WAS A POSITIVE RELATIONSHIP BETWEEN THE NUMBER OF L.C AND THE NUMBER OF LYMPHOCYTES INTHE CONNECTIVE TISSUE ADJACENT TO THE NEOPLASTIC EPITHELIUM. THE FINDINGS ARE INDICATIONS OF A LOCAL IMMUNOLOGIC REACTIONS OF THE HOST TOWARDS THE DEVELOPINGTUMOR, WHICH THROUGH THE IMMUNOLOGIC FUNCTIONS OF L.C AND THE LYMPHOCYTES OF ORAL MUCOSA AND PARTICULARLY THROUGH OF L.C FOR PRESENTING ANTIGENS TO T-LYMPHOCYTES.ΟΙ ΑΝΟΣΟΒΙΟΛΟΓΙΚΕΣ ΔΙΕΡΓΑΣΙΕΣ ΣΤΟ ΒΛΕΝΝΟΓΟΝΟ ΤΟΥ ΣΤΟΜΑΤΟΣ ΠΙΣΤΕΥΕΤΑΙ ΟΤΙ ΠΡΑΓΜΑΤΟΠΟΙΟΥΝΤΑΙ ΚΥΡΙΩΣ ΜΕ ΤΑ LANGERHANS ΚΥΤΤΑΡΑ. ΓΙ'ΑΥΤΟ ΣΚΟΠΟΣ ΤΗΣ ΕΡΓΑΣΙΑΣ ΑΥΤΗΣ ΕΙΝΑΙ Η ΔΙΕΡΕΥΝΗΣΗ ΤΟΥ ΑΚΑΝΘΟΚΥΤΤΑΡΙΚΟΥ ΚΑΡΚΙΝΩΜΑΤΟΣ ΤΟΥ ΣΤΟΜΑΤΟΣ ΓΙΑ ΝΑ ΕΞΑΚΡΙΒΩΘΕΙ Η ΤΥΧΟΝ ΠΑΡΟΥΣΙΑ ΚΑΙ Η ΕΝΔΕΧΟΜΕΝΗ ΑΥΞΗΣΗ 'Η ΜΕΙΩΣΗ ΤΩΝ LANGERHANS ΚΥΤΤΑΡΩΝ Σ'ΑΥΤΟ. ΩΣ ΜΕΘΟΔΟΣ ΑΝΙΧΝΕΥΣΗΣ ΤΩΝ ΚΥΤΤΑΡΩΝ ΑΥΤΩΝ ΧΡΗΣΙΜΟΠΟΙΗΘΗΚΕ Η ΑΝΟΣΟΙΣΤΟΧΗΜΙΚΗ (ΕΜΜΕΣΟΣ ΑΠΕΡΟΞΕΙΔΑΣΗ) ΚΑΙ ΩΣ ΔΕΙΚΤΗΣ (MARKER) Η S-100 ΠΡΩΤΕΙΝΗ. ΤΑ LANGERHANS ΚΥΤΤΑΡΑ (L.C) ΜΕΤΡΗΘΗΚΑΝ ΣΤΙΣ ΕΞΗΣ ΠΕΡΙΟΧΕΣ: ΝΕΟΠΛΑΣΜΑΤΙΚΟ ΕΠΙΘΗΛΙΟ, ΣΤΡΩΜΑ ΤΟΥ ΟΓΚΟΥ, ΦΥΣΙΟΛΟΓΙΚΟ ΕΠΙΘΗΛΙΟ, ΧΟΡΙΟ ΦΥΣΙΟΛΟΓΙΚΟΥ ΕΠΙΘΗΛΙΟΥ. ΒΡΕΘΗΚΕ ΟΤΙ: 1) Η S-100 ΠΡΩΤΕΙΝΗ ΕΙΝΑΙ ΑΡΙΣΤΟΣ ΔΕΙΚΤΗΣ ΓΙΑ ΤΗΝ ΑΝΙΧΝΕΥΣΗ ΤΩΝ ΚΥΤΤΑΡΩΝ L.C ΣΤΟ ΑΚΑΝΘΟΚΥΤΤΑΡΙΚΟ ΚΑΡΚΙΝΩΜΑ ΤΟΥ ΣΤΟΜΑΤΟΣ. 2) Η ΤΕΧΝΙΚΗ ΤΗΣ ΕΜΜΕΣΟΥ ΑΝΟΣΟΥΠΕΡΟΞΕΙΔΑΣΗΣ ΣΕ ΣΥΝΔΥΑΣΜΟ ΜΕ ΤΗ ΧΡΗΣΗ ΘΡΥΨΙΝΗΣ ΕΙΝΑΙ ΙΚΑΝΟΠΟΙΗΤΙΚΗ ΜΕΘΟΔΟΣ ΓΙΑ ΤΗΝ ΜΕΛΕΤΗ ΤΩΝ ΚΥΤΤΑΡΩΝ ΑΥΤΩΝ. 3) ΤΑ L.C ΗΤΑΝ ΠΕΡΙΣΣΟΤΕΡΑ ΣΤΟ ΝΕΟΠΛΑΣΜΑΤΙΚΟ ΕΠΙΘΗΛΙΟ ΠΑΡΑ ΣΤΟ ΦΥΣΙΟΛΟΓΙΚΟ ΕΠΙΘΗΛΙΟ ΚΑΙ ΣΤΟ ΣΤΡΩΜΑ ΤΟΥ ΟΓΚΟΥ ΣΕ ΒΑΘΜΟ ΣΤΑΤΙΣΤΙΚΗΣ ΣΗΜΑΝΤΙΚΟ. 4) ΤΑ L.C ΗΤΑΝ ΠΕΡΙΣΣΟΤΕΡΑ ΣΤΟ ΣΤΡΩΜΑ ΤΟΥ ΟΓΚΟΥ ΠΑΡΑ ΣΤΟ ΧΟΡΙΟ ΤΟΥ ΦΥΣΙΟΛΟΓΙΚΟΥ ΕΠΙΘΗΛΙΟΥ. 5) ΥΠΗΡΧΕ ΘΕΤΙΚΗ ΣΥΣΧΕΤΙΣΗ ΜΕΤΑΞΥ ΤΟΥ ΑΡΙΘΜΟΥ ΤΩΝ L.C ΚΑΙ ΤΟΥ ΑΡΙΘΜΟΥ ΤΩΝ Τ-ΛΕΜΦΟΚΥΤΤΑΡΩΝ ΣΤΟ ΣΤΡΩΜΑ ΤΟΥ ΟΓΚΟΥ. ΤΑ ΕΥΡΗΜΑΤΑ ΑΥΤΑ ΥΠΟΔΗΛΩΝΟΥΝ ΟΤΙ ΣΤΟ ΑΚΑΝΘΟΚΥΤΤΑΡΙΚΟ ΚΑΡΚΙΝΩΜΑ ΤΟΥ ΣΤΟΜΑΤΟΣ ΑΝΑΠΤΥΣΣΕΤΑΙ ΜΙΑ ΤΟΠΙΚΗ ΑΝΟΣΟΛΟΓΙΚΗ ΑΝΤΙΔΡΑΣΗ, ΠΟΥ ΕΚΦΡΑΖΕΤΑΙ ΜΕΣΩ ΤΩΝ L.C ΚΑΙ ΤΩΝ ΛΕΜΦΟΚΥΤΤΑΡΩΝ. Ο ΡΟΛΟΣ ΤΩΝ L.C ΦΑΙΝΕΤΑΙ ΟΤΙ ΕΙΝΑΙ ΠΡΩΤΑΡΧΙΚΗΣ ΣΗΜΑΣΙΑΣ ΚΑΙ ΣΤΗΡΙΖΕΤΑΙ ΚΥΡΙΩΣ ΣΤΗΝ ΙΔΙΟΤΗΤΑ, ΠΟΥ ΕΧΟΥΝ ΝΑ ΠΑΡΟΥΣΙΑΖΟΥΝ ΑΝΤΙΓΟΝΑ, ΣΤΑ Τ- ΛΕΜΦΟΚΥΤΤΑΡΑ

Biologic agents and oral diseases; therapeutic prospects and restrictions

Abstract: Biologic agents (BAs) are synthesized by the products of living organisms and are widely used in the treatment of inflammatory and neoplastic conditions with favorable results. The purpose of this review is to provide an update of the biologic agents reported to have been used in treatment of diseases that affect the oral mucosa, as off-label indications. Identification of cases studies referring to the use of biologic agents in patients with Sjögren syndrome (including patients with MALT-lymphomas), pemphigus (vulgaris, foliaceous, paraneoplastic), mucous membrane pemphigoid, oral lichen planus, Behcet’s disease, orofacial granulomatosis, and recurrent aphthous ulceration (RAU), was achieved using Pubmed –Medline database , performing both electronic search (with key words infliximab, etanercept, adalimumab, rituximab, efalizumab, epratuzumab and alefacept , oral diseases, oral manifestations, dermatologic diseases, immune mediated diseases, biologic agents , anti-TNF agents, monoclonal antibodies, anti-B cell agents, anti T-cell agents ) and hand search to identify articles that referred specifically to patients with oral involvement..  According to the literature so far the use of BAs in patients that suffered from refractory forms of the immune-related diseases of the oral mucosa seems in general a clinically encouraging therapeutic option, but not without side effects including secondary infections, and also with a questionable economic cost-effect. Indeed, more studies in larger groups and longer period of time are required in order to confirm their efficacy and safety.  </p

Real world evidence: Patients with refractory pemphigus treated with Rituximab.

BACKGROUND: Pemphigus is a group of autoimmune blistering diseases, potentially life-threatening. Rituximab received FDA approval in June 2018 for the treatment of moderate to severe pemphigus vulgaris. OBJECTIVES: To evaluate the efficacy and safety of rituximab in patients with pemphigus, resistant to previous therapies or unable to receive classic immunosuppressive treatment due to serious adverse events or comorbidities. MATERIALS AND METHODS: Twenty-five patients (9 men, 16 women), mean age 49.4 ± 15.9 years (range 21-74 years), mean disease duration 4 ± 2.7 years (range 0.25-10 years) were included in the study: 19 patients with pemphigus vulgaris and 6 with pemphigus foliaceous. The efficacy of rituximab was evaluated according to the control of disease, retention of remission, disease severity, previous treatments and adverse reactions. During COVID-19 pandemic patients are monitored closely through tele-dermatology. RESULTS: Twenty-three out of 25 patients had great improvement, 2 out of 25 ceased therapy due to adverse events (arthralgias and dyspnea). Sixteen out of 23 received additional course after 8 months (range 5-60 months). More aged patients presented more frequently adverse events and underwent additional courses (p = 0.002). Rituximab was found superior to classic immunosuppressive treatment in terms of efficacy and safety, with larger periods of remission and lower doses of corticosteroids and immunosuppressants. No major adverse events were noticed. CONCLUSIONS: Rituximab is a very effective treatment of pemphigus and, remarkably, superior to classic immunosuppressive treatment

Relationship Between Foveal Cone Structure and Visual Acuity Measured With Adaptive Optics Scanning Laser Ophthalmoscopy in Retinal Degeneration.

PurposeTo evaluate foveal function in patients with inherited retinal degenerations (IRD) by measuring visual acuity (VA) after correction of higher-order aberrations.MethodsAdaptive optics scanning laser ophthalmoscopy (AOSLO) was used to image cones in 4 healthy subjects and 15 patients with IRD. The 840-nm scanning laser delivered an "E" optotype to measure AOSLO-mediated VA (AOSLO-VA). Cone spacing was measured at the preferred retinal locus by two independent graders and the percentage of cones below the average density of 47 age-similar healthy subjects was computed. Cone spacing was correlated with best-corrected VA measured with the Early Treatment of Diabetic Retinopathy Study protocol (ETDRS-VA), AOSLO-VA, and foveal sensitivity.ResultsETDRS-VA significantly correlated with AOSLO-VA (ρ = 0.79, 95% confidence interval [CI] 0.5-0.9). Cone spacing correlated with AOSLO-VA (ρ = 0.54, 95% CI 0.02-0.7), and negatively correlated with ETDRS letters read (ρ = -0.64, 95% CI -0.8 to -0.2). AOSLO-VA remained ≥20/20 until cones decreased to 40.2% (CI 31.1-45.5) below normal. Similarly, ETDRS-VA remained ≥20/20 until cones were 42.0% (95% CI 36.5-46.1) below normal. Cone spacing z scores negatively correlated with foveal sensitivity (ρ = -0.79, 95% CI -0.9 to -0.4) and foveal sensitivity was ≥35 dB until cones were 43.1% (95% CI 39.3-46.6) below average.ConclusionsVA and foveal cone spacing were weakly correlated until cones were reduced by 40% to 43% below normal. The relationship suggests that VA is an insensitive measure of foveal cone survival; cone spacing may be a more sensitive measure of cone loss

Loss of Foveal Cone Structure Precedes Loss of Visual Acuity in Patients With Rod-Cone Degeneration.

PurposeTo assess the relationship between cone spacing and visual acuity in eyes with rod-cone degeneration (RCD) followed longitudinally.MethodsHigh-resolution images of the retina were obtained using adaptive optics scanning laser ophthalmoscopy from 13 eyes of nine RCD patients and 13 eyes of eight healthy subjects at two sessions separated by 10 or more months (mean 765 days, range 311-1935 days). Cone spacing Z-score measured as close as possible (average &lt;0.25°) to the preferred retinal locus was compared with visual acuity (letters read on the Early Treatment of Diabetic Retinopathy Study [ETDRS] chart and logMAR) and foveal sensitivity.ResultsCone spacing was significantly correlated with ETDRS letters read (ρ = -0.47, 95%CI -0.67 to -0.24), logMAR (ρ = 0.46, 95%CI 0.24 to 0.66), and foveal sensitivity (ρ = -0.30, 95%CI -0.52 to -0.018). There was a small but significant increase in mean cone spacing Z-score during follow-up of +0.97 (95%CI 0.57 to 1.4) in RCD patients, but not in healthy eyes, and there was no significant change in any measure of visual acuity.ConclusionsCone spacing was correlated with visual acuity and foveal sensitivity. In RCD patients, cone spacing increased during follow-up, while visual acuity did not change significantly. Cone spacing Z-score may be a more sensitive measure of cone loss at the fovea than visual acuity in patients with RCD

A Smartphone-Based Tool for Rapid, Portable, and Automated Wide-Field Retinal Imaging.

Purpose:High-quality, wide-field retinal imaging is a valuable method for screening preventable, vision-threatening diseases of the retina. Smartphone-based retinal cameras hold promise for increasing access to retinal imaging, but variable image quality and restricted field of view can limit their utility. We developed and clinically tested a smartphone-based system that addresses these challenges with automation-assisted imaging. Methods:The system was designed to improve smartphone retinal imaging by combining automated fixation guidance, photomontage, and multicolored illumination with optimized optics, user-tested ergonomics, and touch-screen interface. System performance was evaluated from images of ophthalmic patients taken by nonophthalmic personnel. Two masked ophthalmologists evaluated images for abnormalities and disease severity. Results:The system automatically generated 100° retinal photomontages from five overlapping images in under 1 minute at full resolution (52.3 pixels per retinal degree) fully on-phone, revealing numerous retinal abnormalities. Feasibility of the system for diabetic retinopathy (DR) screening using the retinal photomontages was performed in 71 diabetics by masked graders. DR grade matched perfectly with dilated clinical examination in 55.1% of eyes and within 1 severity level for 85.2% of eyes. For referral-warranted DR, average sensitivity was 93.3% and specificity 56.8%. Conclusions:Automation-assisted imaging produced high-quality, wide-field retinal images that demonstrate the potential of smartphone-based retinal cameras to be used for retinal disease screening. Translational Relevance:Enhancement of smartphone-based retinal imaging through automation and software intelligence holds great promise for increasing the accessibility of retinal screening