Non-invasive Approaches for the Diagnosis of Autoimmune/Autoinflammatory Skin Diseases—A Focus on Psoriasis and Lupus erythematosus

The traditional diagnostic gold standard for inflammatory skin lesions of unclear etiology is dermato-histopathology. As this approach requires an invasive skin biopsy, biopsy processing and analysis by specialized histologists, it is a resource intensive approach requiring trained healthcare professionals. In many health care settings access to this diagnostic approach can be difficult and outside emergency cases will usually take several weeks. This scenario leads to delayed or inappropriate treatment given to patients. With dramatically increased sensitivity of a range of analysis systems including mass spectrometry, high sensitivity, multiplex ELISA based systems and PCR approaches we are now able to “measure” samples with unprecedented sensitivity and accuracy. Other important developments include the long-term monitoring of parameters using microneedle approaches and the improvement in imaging systems such as optical coherence tomography. In this review we will focus on recent achievements regarding measurements from non-invasive sampling, in particular from plucked hair and skin tape-strips which seem well suited for the diagnosis of lupus erythematosus and psoriatic inflammation, respectively. While these approaches will not replace clinical observation—they can contribute to improved subgroup diagnosis, stratified therapeutic approaches and have great potential for providing molecular and mechanistic insight in to inflammatory skin diseases.With dramatically increased sensitivity of a range of analysis systems including mass spectrometry, high sensitivity, multiplex ELISA based systems and PCR approaches we are now able to “measure” samples with unprecedented sensitivity and accuracy. Other important developments include the long-term monitoring of parameters using microneedle approaches and the improvement in imaging systems such as optical coherence tomography. In this review we will focus on recent achievements regarding measurements from non-invasive sampling, in particular from plucked hair and skin tape-strips which seem well suited for the diagnosis of lupus erythematosus and psoriatic inflammation, respectively. While these approaches will not replace clinical observation – they can contribute to improved subgroup diagnosis, stratified therapeutic approaches and have great potential for providing molecular and mechanistic insight in to inflammatory skin disease

Environmental factors and allergic diseases

An objective of this article is a review of contemporary knowledge on various environmental factors, that influence prevalence and course of allergic diseases, like asthma, allergic rhinitis, atopic dermatitis and also contact dermatitis. Surrounding climate may directly influence each patient, but also determines type of flora and fauna within particular geographical regions and thus affects sources of airborne and food allergens. Epidemiological studies suggest that there is a strong relationship between air pollution and development and exacerbation of asthma and other allergic diseases – main attention has been concentrated on gaseous materials such as ozone (O3) and nitrogen dioxide (NO2), as well as particulate matter (PM), generated by car traffic and industry. Diesel exhaust particulate (DEP) has the ability to bind proteins and may serve as a potential carrier of allergens, penetrating deep into respiratory tract. Among the most extensively studied environmental factors influencing allergy are airborne allergens: dust mites, pollens, fungi and animal dander. Foods may elicit both true IgE-mediated allergy and also various non-immunological reactions, associated with direct release of mediators or toxic activity. It has been estimated, that over 85 000 chemicals are recognized in the human environment and they may act as contact allergens or irritants, causing allergic or non-allergic contact dermatitis. Among them metals, fragrances, preservatives, botanicals and paraphenylenediamine are considered as the most significant. Infections have always been associated with etiopathogenesis of allergic diseases and they may contribute to exacerbation of their course