Nonsegmental vitiligo update

AbstractNonsegmental vitiligo is an acquired leukoderma characterized by the destruction of melanocytes. Autoimmunity is the most widely accepted hypothesis to explain the pathogenesis of nonsegmental vitiligo. Increased oxidative stress and decreased expression of E-cadherin may facilitate the loss of melanocytes. Because vitiligo preferentially affects cosmetically sensitive regions such as the face, hands, and genital area, it imposes significant psychological and social burdens. In this review, we discuss recent topics in the epidemiology, pathogenesis, genetic background, and therapeutic advances of nonsegmental vitiligo

Topical tacrolimus as treatment of atopic dermatitis

Atopic dermatitis (AD) is a common, chronic, relapsing, severely pruritic, eczematous skin disease. The mainstays of treatment for AD are topical tacrolimus and topical steroids. Tacrolimus, a calcineurin inhibitor, not only complements existing treatment options but also overcomes some of the drawbacks of topical steroid therapy when given topically and thus meets the long-term needs of patients in preventing disease progression. Topical tacrolimus has been widely recognized in terms of its short- and long-term efficacies and safety, and it is also accepted as a first-line treatment for inflammation in AD. The recent proactive use of topical tacrolimus may emphasize a long-term benefit of this calcineurin inhibitor for AD treatment. To reduce possible long-term adverse effects, it is important to monitor its topical doses in daily clinics

Combination cryosurgery with hyperthermia in the management of skin metastasis from breast cancer: a case report

Introduction: Skin metastases may impair the quality of life due to physical appearance, odour, and bleeding. Presentation of Case: A 70-year-old woman presented with two enlarging nodules (measuring 12 cm and 3 cm in diameter) consistent with metastatic breast cancer in the left subclavicular area. The larger tumour did not respond to initial cryosurgery. Therefore we added hyperthermia using a disposable body warmer. In addition, the cryosurgery technique was modified to freeze deeper tissue. The entire tumour was covered with dry cotton, to which liquid nitrogen was applied. Twenty weeks later, the tumour became nearly flat and the patient noted improved activity in her daily life. Discussion: Combination treatment with sufficient freezing is important for controlling the tumour, while hyperthermia may accelerate the antitumor effects of cryosurgery. Conclusion: This treatment provides an alternative for unresectable breast cancer skin metastases resistant to chemotherapy and radiotherapy

Role of the Arylhydrocarbon Receptor (AhR) in the Pathology of Asthma and COPD

The dioxins and dioxin-like compounds in cigarette smoke and environmental pollutants modulate immunological responses. These environmental toxicants are known to cause lung cancer but have also recently been implicated in allergic and inflammatory diseases such as bronchitis, asthma, and chronic obstructive pulmonary disease (COPD). In a novel pathway of this response, the activation of a nuclear receptor, arylhydrocarbon receptor (AhR), mediates the effects of these toxins through the arachidonic acid cascade, cell differentiation, cell-cell adhesion interactions, cytokine expression, and mucin production that are implicated in the pathogenesis and exacerbation of asthma/COPD. We have previously reported that human bronchial epithelial cells express AhR, and AhR activation induces mucin production through reactive oxygen species. This review discusses the role of AhR in asthma and COPD, focusing in particular on inflammatory and resident cells in the lung. We describe the important impact that AhR activation may have on the inflammation phase in the pathology of asthma and COPD. In addition, crosstalk of AhR signaling with other ligand-activated transcription factors such as peroxisome proliferator-activated receptors (PPARs) has been well documented

Occult Basal Cell Carcinoma Arising in Seborrheic Keratosis

Both seborrheic keratosis and basal cell carcinoma are common skin tumors in daily clinical practice. However, the coexistence of seborrheic keratosis and basal cell carcinoma is rare. In this report, we present a case of occult microscopic basal cell carcinoma arising in a lesion of seborrheic keratosis. This case indicates that the basal cell carcinoma could arise from seborrheic keratosis and might help to clarify the origin of basal cell carcinoma

Successful Treatment of Epidermal Growth Factor Receptor Inhibitor-Induced Periungual Inflammation with Adapalene

Epidermal growth factor receptor (EGFR) inhibitors are increasingly used for cancer treatment, but commonly carry dermatologic side effects. Periungual inflammation is a particularly painful condition that additionally worsens quality of life. In this paper, we report 3 cases of successful treatment of periungual inflammation induced by 3 different EGFR inhibitors (gefitinib, erlotinib, and cetuximab) with topically applied adapalene

Activation Pattern of Langerhans Cells in the Afferent and Efferent Phases of Contact Hypersensitivity

Langerhans cells are MHC class II (Ia) positive antigen- presenting cells that play a crucial role in the induction of contact hypersensitivity (CHS). The topical application of a hapten modifies the cell surface moieties of Langerhans cells, and activates Langerhans cells to increase their size and Ia intensity. The haptenated and activated Langerhans cells emigrate from the epidermis and thus the in situ density of Langerhans cells usually decreases during 24-48h after the hapten application in CHS. To determine whether the early activation pattern of Langerhans cells is different between the afferent phase and the efferent phase of CHS, we compared the density and morphologic changes of Langerhans cells in CHS to trinitrochlorobenzene using nonsensitized and sensitized mice. We found that the application of a hapten induces more significant enlargement of Langerhans cell size in the afferent phase than in the efferent phase, whereas the reduction of Langerhans cell density is more marked in the efferent than in the afferent phase of CHS. Moreover, topical immunosuppressive drugs inhibit the in situ activation of Langerhans cells

Measurement of trihydroxy-linoleic acids in stratum corneum by tape-stripping: Possible biomarker of barrier function in atopic dermatitis

Epidermal ceramides are indispensable lipids that maintain the functions of the stratum corneum. Esterified omega-hydroxyacyl-sphingosine (EOS) ceramide with a linoleate moiety is one of the most important ceramide species for forming cornified lipid envelopes. This linoleate moiety is eventually metabolized to trihydroxy-linoleic acid (triol, 9,10,13-trihydroxy-11-Eoctadecenoic acid). Thus, we assumed that a decrease of triols might reflect skin barrier dysfunction. Against this background, the purposes of this study were to measure the triols by a simple tape-stripping method and to determine the correlation between the amount of triols and transepidermal water loss (TEWL) as an indicator of barrier dysfunction in atopic dermatitis patients. Twenty Japanese subjects with normal skin and 20 atopic dermatitis patients were enrolled in this study. TEWL was measured and triols of the stratum corneum were analyzed by tape-stripping. The results showed for the first time that triols in the stratum corneum could be simply measured using the tape-stripping method. The triol levels in atopic dermatitis patients were much higher than those in healthy subjects. Moreover, the triol levels correlated with TEWL of non-lesional forearm skin in patients with atopic dermatitis. The results suggest that the assaying of triol levels via non-invasive tape-stripping could be beneficial for monitoring barrier function in atopic dermatitis

The Relationship between Symptom Flare of Atopic Dermatitis and Airborne Japanese Cedar and Cypress Pollen Counts: A Self-Scoring Diary Study

Background. With an increase in Japanese cedar and cypress (JC) pollinosis, the relationship between JC pollen and atopic dermatitis (AD) has been studied. Some reports suggest that JC pollen can be one exacerbating factor for AD, but there has been no report that discusses JC pollen counts relating to AD symptom flare although actual airborne JC pollen counts can widely fluctuate throughout the pollen season. Objective. The relationship between symptom flare of AD and airborne JC pollen counts was examined. Methods. We monitored JC pollen counts in real time and divided the counts into low and high level. We then analyzed self-scored “itch intensity” recorded by 14 AD patients through a self-scoring diary. Results. Among the 14 patients, 7 had significantly higher itch intensity while the pollen counts were high. Conclusion. Even during the pollen season, actual airborne pollen counts can widely fluctuate. Our study suggested that symptom flare of AD could be influenced by the actual pollen counts